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Epidural/Echo/Coagulation

Aprotinin reduces bleeding after off-pump coronary artery bypass surgery: 002

Meyer, C.; Durand, M.; Chavanon, O.; Lefevre, M.; Berthet, M. C.; Girardet, P.; Blin, D.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 33

Introduction: Aprotinin is an antifibrinolytic agent which reduces blood loss after cardiac surgery under CPB [1]. Only one study has evaluated the effect of aprotinin during off-pump (OPCAB) surgery. The aim of this study was to evaluate the efficacy of aprotinin in reducing blood loss after OPCAB.

Method: A retrospective study based on our prospective database compared 40 patients operated on before the routine use of aprotinin (Group O) to 40 patients who received a full dose of aprotinin (Group A). Post operative blood loss, transfusion rate and troponin levels were compared between the 2 groups. 90% of the patients received aspirin until the day of surgery. During operation, patients received 300UI/kg of heparin and complete reversal with protamine at the end of surgery. Packed red blood cells were transfused when haemoglobin concentration was less than 80 g L−1. Groups were compared with t test or Χ2 test when appropriate. Results are given as mean ± SD.

Results: Aprotinin significantly reduces blood loss but not transfusion. Main results are summarized in the table.

Table
Table:
No Caption available.

Discussion: Aprotinin significantly reduces blood loss after OPCAB surgery. Using aprotinin with a full dose of heparin did not increase postoperative values of troponin.

References:

1 Dietrich WJ, Barankay A, Hähnel Ch, et al. High-dose aprotinin in cardiac surgery: three years' experience in 1784 patients. J Cardiothorac Vasc Anesth 1992; 6(3): 324-327.
2 Englberger L, Makart P, Eckstein FS, et al. Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery. Eur J Cardiothorac Surg 2002; 22(4): 545-551.
© 2004 European Society of Anaesthesiology