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[The use of antifibrinolytics in heart surgery. 3 prospective studies]
M T Cousin1, F Boughenou, S Madi-Jebara
1Service d'Anesthésie-Réanimation chirurgicale, Hôpital Broussais, Paris.
Insights
Antifibrinolytic treatments like tranexamic acid and aprotinin reduce bleeding in cardiac surgery. However, tranexamic acid was linked to a rare case of valvular thrombosis post-operation.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Hematology
Background:
- Antifibrinolytic agents are used to reduce bleeding during cardiac surgery.
- Aprotinin and tranexamic acid are common antifibrinolytics with varying efficacy and safety profiles.
- Optimizing antifibrinolytic strategies is crucial for patient outcomes in cardiac procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of different antifibrinolytic treatments in cardiac surgery patients.
- To compare low-dose aprotinin, standard-dose aprotinin, and tranexamic acid.
- To assess the impact on postoperative bleeding, transfusion requirements, platelet function, and complications like thrombosis and renal dysfunction.
Main Methods:
- Three controlled, randomized, double-blind studies were conducted in patients undergoing first or repeat cardiac surgery.
- Study I: Low-dose aprotinin vs. standard-dose aprotinin vs. placebo.
- Study II: Tranexamic acid vs. low-dose aprotinin vs. placebo.
- Study III: Tranexamic acid vs. standard-dose and reduced-dose aprotinin in repeat procedures.
Main Results:
- Reduced postoperative bleeding was observed in non-placebo groups in Studies I and II.
- Study III showed no significant difference in bleeding between tranexamic acid and aprotinin groups.
- Tranexamic acid demonstrated comparable efficacy to aprotinin in maintaining platelet function.
- No significant changes in serum creatinine were noted.
- One case of non-obstructive valvular thrombosis occurred in the tranexamic acid group during the second postoperative week.
Conclusions:
- Both aprotinin and tranexamic acid are effective in reducing bleeding and maintaining platelet function during cardiac surgery.
- While generally safe, tranexamic acid may be associated with a rare risk of thrombosis.
- Further research may be needed to fully elucidate the long-term safety and comparative effectiveness of these agents.
Abstract:
In order to assess the validity of antifibrinolytic treatments in cardiac surgery, three successive controlled randomized double-blind studies were carried out in patients undergoing a first (n = 60) or repeat surgical procedure because of a valvular or coronary disease. The first study aimed at stating the value of low doses of aprotinin compared with "classical" ones and a placebo. The second study was planned to compare tranexamic acid with low-dosed aprotinin and a placebo. The last study applied to reiterated procedures and compared tranexamic acid with classical and reduced aprotinin dosages, without a placebo group. Effects were estimated on postoperative bleeding, blood transfusions, platelets function and possible complications such as thrombosis or seric creatinine elevation. A reduced bleeding was observed in the non-placebo groups of studies I and II. The 3d study did not show any significant differences in this respect between the three methods. Tranexamic acid was found as effective as aprotinin on platelets function. No significant changes of seric creatinine was observed from preoperative to 4th postoperative day. A valvular non-obstructive thrombosis occurred on the second postoperative week in the tranexamic acid group.