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Topical aprotinin in cardiac operations
D J O'Regan1, N Giannopoulos, N Mediratta
1Oxford Heart Centre, John Radcliffe Hospital, England.
The Annals of Thoracic Surgery
|September 1, 1994
Summary
Topical aprotinin significantly reduced blood loss and the need for blood transfusions in cardiac surgery patients. This antifibrinolytic agent shows promise for managing excessive postoperative bleeding.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Postoperative bleeding is a significant complication in cardiac operations.
- Cardiopulmonary bypass procedures increase the risk of bleeding.
- Aprotinin is a serine protease inhibitor with potential antifibrinolytic properties.
Purpose of the Study:
- To evaluate the efficacy of topical aprotinin in reducing blood loss during cardiac surgery.
- To compare blood loss and transfusion requirements between aprotinin and placebo groups.
Main Methods:
- Prospective, randomized, double-blind trial.
- 100 patients undergoing cardiac operations with cardiopulmonary bypass.
- Topical application of aprotinin (50 mL; 70 mg) or placebo to the heart, pericardium, and mediastinum before sternal closure.
Main Results:
- Mean blood loss was significantly lower in the aprotinin group (653 mL) compared to placebo (903 mL; p = 0.002).
- Fewer patients in the aprotinin group received blood transfusions (67.5%) versus the placebo group (88%; p = 0.03).
- A significant difference in blood loss was observed when aspirin was discontinued two weeks prior to surgery.
Conclusions:
- Topical aprotinin is effective in reducing blood loss and transfusion needs in cardiac surgery.
- Intrapericardial aprotinin instillation offers a potential solution for managing excessive postoperative bleeding.
- The efficacy of aprotinin may be influenced by concomitant aspirin use.