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Coagulation

Ultra low dose aprotinin decreases blood loss and transfusion requirements in high risk two valve replacement surgery: 075

Muralidhar, K.; Harish, B. R.; Sanjay, B.; Rajnish, G.; Murthy, K.; Dhaded, S.; John, C.; Praveen, K.; Shetty, D. P.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 11
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Introduction: Antifibrinolytics have been extensively used in cardiac surgery involving cardiopulmonary bypass, orthotopic liver transplantation and in extensive surgical procedures to decrease perioperative bleeding. This study was conducted to assess the safety and efficacy of ultra low dose aprotinin in reducing postoperative blood loss in patients undergoing ‘high-risk’ two valve replacements.

Method: Forty patients of NYHA class IV undergoing elective combined mitral and aortic valve replacement surgery were randomized into 2 groups of twenty each. Group I received aprotinin in a dose of 1 million KIU (after anaesthetic induction prior to initiation of cardiopulmonary bypass); Group II received no antifibrinolytic. A standard technique of anaesthesia and extracorporeal circulation was instituted. Tests of coagulation were done at periodic intervals, quantity of blood and blood products transfused were recorded postoperatively. Numerical data were statistically analysed (Student's t test) and P < 0.05 was considered significant.

Results: The demographic data were comparable in the two groups. There was significant reduction in mediastinal drainage and blood or blood products transfusion requirements with the use of low dose aprotinin (Table 1). There were no significant differences regarding duration of ventilation, duration of ITU stay and morbidity in the two groups. There was reduction in cost associated with use of aprotinin.

Table 1
Table 1:
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Conclusion: The routine use of aprotinin 1 million KIU in coronary artery bypass grafting with left internal mammary artery has been recommended to reduce cost and transfusion requirements [1]. Prophylactic administration of ultra low dose aprotinin reduced transfusions in patients undergoing repeat operations or complex procedures [2]. Our data support routine use of ultra low dose aprotinin in “high risk” two-valve replacement surgery to reduce postoperative blood loss and to decrease the number of blood or blood product transfusions.

References:

1 Dignan RJ, Law DW, Seah PW, et al. Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary operations. Ann Thorac Surg 2001; 71(1): 158-163.
2 Hardy JF, Belisle S, Couturier A, et al. Randomized, placebo-controlled, double-blind study of an ultra low dose aprotinin regimen in reoperative and/or complex cardiac operations. J Card Surg 1997; 12(1): 15-22.
© 2004 European Society of Anaesthesiology