Premium
Reduction of Blood Loss and Transfusion Requirements After Coronary Artery Bypass Grafting: Similar Efficacy of Tranexamic Acid and Aprotinin in Aspirin‐treated Patients
Author(s) -
Bernet Franziska,
Carrel Thierry,
Marbet German,
Skarvan Karl,
Stulz Peter
Publication year - 1985
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.1985.tb01253.x
Subject(s) - tranexamic acid , medicine , aprotinin , aspirin , anesthesia , myocardial infarction , perioperative , antifibrinolytic , surgery , cardiology , blood loss
Background: In patients with coronary artery disease, continuation of aspirin may reduce the incidence of unstable angina and preoperative myocardial infarction before surgery, but the risk of perioperative bleeding may be increased. Methods: The efficacy of aprotinin and tranexamic acid (TXA) was examined in a prospective, randomized, double‐blind trial involving 56 patients scheduled for coronary artery bypass grafting and who received aspirin 100 mg/day until the day of the operation. Group I received high‐dose aprotinin whereas group II received 10 g of tranexamic acid (TXA) over 20 minutes before sternotomy. Heparinization during cardiopul‐monary bypass was controlled with HDTT (high‐dose thrombin time) to eliminate interference of aprotinin on ACT (celite activated clotting time). Postoperative blood loss and transfusion requirements were registered during the first 24 hours. Results: The demographics, coagulation, and intraoperative parameters were similar in both groups. Postoperative blood loss (aprotinin 840 mL /24 hours, TXA 880 mL/24 hours, p = 0.481). and transfusion requirements (2.18 units/patient in the aprotinin group, 2.11 units/patient in the TXA group) were not remarkably different between the two regimen protocols. No perioperative myocardial infarction, pulmonary embolism, cerebrovascular event, or other thrombotic events were observed. Conclusions: In this trial, we were not able to demonstrate any difference in postoperative bleeding in patients pre‐treated with aspirin after high‐dose aprotinin or TXA. From a practical point of view, TXA is safe, less expensive than aprotinin, and easy to handle, and can be recommended in patients pre‐treated with aspirin to improve postoperative hemostasis.