Article

Bleeding in cardiac surgery: the use of aprotinin does not affect survival.

Department of Cardiothoracic Surgery, University Hospital Birmingham, Birmingham, United Kingdom.
The Journal of thoracic and cardiovascular surgery (impact factor: 3.41). 04/2008; 135(3):495-502. DOI:10.1016/j.jtcvs.2007.11.045 pp.495-502
Source: PubMed

ABSTRACT The antifibrinolytic drug aprotinin has been the most widely used agent to reduce bleeding and its complications in cardiac surgery. Several randomized trials and meta-analyses have demonstrated it to be effective and safe. However, 2 recent reports from a single database have implicated the use of aprotinin as a risk for postoperative complications and reduced long-term survival.
In this single-institution observational study involving 7836 consecutive patients (1998-2006), we assessed the safety of using aprotinin in risk reduction strategy for postoperative bleeding.
Aprotinin was used in 44% of patients. Multivariate analysis identified aprotinin use in risk reduction for reoperation for bleeding (odds ratio, 0.51; 95% confidence interval, 0.36-0.72; P = .001) and need for blood transfusion postoperatively (odds ratio, 0.67; 95% confidence interval, 0.57-0.79; P = .0002). The use of aprotinin did not affect in-hospital mortality (odds ratio, 1.03; 95% confidence interval, 0.71-1.49; P = 0.73), intermediate-term survival (median follow-up, 3.4 years; range, 0-8.9 years; hazard ratio, 1.09; 95% confidence interval, 0.93-1.28; P = .30), incidence of postoperative hemodialysis (odds ratio, 1.16; 95% confidence interval, 0.73-1.85; P = .49), and incidence of postoperative renal dysfunction (odds ratio, 0.78; 95% confidence interval, 0.59-1.03; P = .07).
This study demonstrates that aprotinin is effective in reducing bleeding after cardiac surgery, is safe, and does not affect short- or medium-term survival.

0 0
 · 
0 Bookmarks
 · 
33 Views
  • Source
    Article: A comparison before and after aprotinin was suspended in cardiac surgery: different results in the real world from a single cardiac center in China.
    Xianqiang Wang, Zhe Zheng, Hushan Ao, Shiju Zhang, Yang Wang, Hao Zhang, Lihuan Li, Shengshou Hu
    [show abstract] [hide abstract]
    ABSTRACT: Use of aprotinin has been suspended in cardiac surgery since recent studies reported its risks associated with mortality and other adverse events. This study was to investigate the safety and efficacy of aprotinin through a comparison before and after aprotinin was suspended in cardiac surgery. We designed a case-control study in two groups of patients who underwent cardiac surgery just before and after aprotinin was suspended in China. The aprotinin group (n = 1699) was defined as operations performed from June 19, 2007, to December 18, 2007, when aprotinin was used in all the patients. The control group (n = 2225) was defined as operations performed from December 19, 2007, to June 18, 2008, when aprotinin was not used. We compared early postoperative outcomes between the two groups. The aprotinin group had less postoperative blood loss, transfusion requirement, and reoperation for bleeding. Application of aprotinin did not increase the risk of in-hospital mortality (0.5% vs 1.0%; P = .08) and other major adverse outcome events, including renal, cardiac, neurologic, and pulmonary complications. The aprotinin group had a shorter mechanical ventilation time (P = .04), a lower rate of delayed mechanical ventilation time (P = .04), and a higher arterial oxygen tension/inspired oxygen fraction ratio in arterial blood gas analysis (P < .001). Multivariable logistic regression analysis confirmed findings from univariate analysis. After propensity adjustment for the baseline characteristics, we obtained similar results. Use of aprotinin in cardiac surgery could reduce blood loss and transfusion requirement significantly and showed a protective effect on the lungs, but it did not increase the risk of mortality or major complications.
    The Journal of thoracic and cardiovascular surgery 05/2009; 138(4):897-903. · 3.41 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

2 recent reports
 
7836 consecutive patients
 
95% confidence interval
 
antifibrinolytic drug aprotinin
 
blood transfusion postoperatively
 
cardiac surgery
 
hazard ratio
 
in-hospital mortality
 
intermediate-term survival
 
long-term survival
 
median follow-up
 
medium-term survival
 
Multivariate analysis
 
odds ratio
 
postoperative renal dysfunction
 
randomized trials
 
reoperation
 
risk reduction
 
risk reduction strategy
 
single-institution observational study
 

Domenico Pagano