OBJECTIVE: Aprotinin reduces the blood loss and transfusion of blood products in children undergoing major surgery. Aprotinin has been associated with severe side effects in adults, and tranexamic acid and aminocaproic acid have been found to be safer alternatives in adults. This systematic review addresses the question of whether tranexamic acid and aminocaproic acid are equally effective as aprotinin for reducing blood loss and transfusion in children undergoing major surgery. DATA SOURCES: A systematic review of the literature was conducted to identify all randomized controlled trials of aprotinin, tranexamic acid, and aminocaproic acid involving children undergoing cardiac or scoliosis surgery. STUDY SELECTION AND DATA EXTRACTION: Twenty-three cardiac studies, totaling 1893 patients, met the inclusion criteria. None of the studies directly compared aprotinin to an alternative antifibrinolytic. Five scoliosis studies, totaling 207 patients, met the inclusion criteria. Data on blood loss and use of blood products in the first 24 postoperative hours were extracted. Only homogenously distributed outcomes were pooled. DATA SYNTHESIS: Tranexamic acid showed a homogeneously distributed reduction of blood loss by 11 mL/kg (95% confidence interval [CI] 9-13 mL/kg). Outcomes of blood loss reduction by aprotinin and aminocaproic acid were too heterogeneously distributed to be pooled, so the effect on blood loss could not be evaluated. Both aprotinin and tranexamic acid significantly reduced packed red cell transfusion (4 mL/kg, 95% CI 2-7 mL/kg and 7 mL/kg, 95% CI 5-10 mL/kg, respectively). Type of antifibrinolytic was not a determining factor that explained differences in outcome among trials in a meta-regression analysis. In the scoliosis studies, aprotinin and tranexamic acid significantly reduced blood loss compared with placebo (385 mL, 95% CI 727-42 mL and 682 mL, 95% CI 1149-214 mL, respectively). CONCLUSIONS: There is no evidence that suggests that, compared with aprotinin, alternative antifibrinolytics such as tranexamic acid were less effective in reducing blood loss in major pediatric surgery.
OBJECTIVE: Aprotinin reduces the blood loss and transfusion of blood products in children undergoing major surgery. Aprotinin has been associated with severe side effects in adults, and tranexamic acid and aminocaproic acid have been found to be safer alternatives in adults. This systematic review addresses the question of whether tranexamic acid and aminocaproic acid are equally effective as aprotinin for reducing blood loss and transfusion in children undergoing major surgery. DATA SOURCES: A systematic review of the literature was conducted to identify all randomized controlled trials of aprotinin, tranexamic acid, and aminocaproic acid involving children undergoing cardiac or scoliosis surgery. STUDY SELECTION AND DATA EXTRACTION: Twenty-three cardiac studies, totaling 1893 patients, met the inclusion criteria. None of the studies directly compared aprotinin to an alternative antifibrinolytic. Five scoliosis studies, totaling 207 patients, met the inclusion criteria. Data on blood loss and use of blood products in the first 24 postoperative hours were extracted. Only homogenously distributed outcomes were pooled. DATA SYNTHESIS: Tranexamic acid showed a homogeneously distributed reduction of blood loss by 11 mL/kg (95% confidence interval [CI] 9-13 mL/kg). Outcomes of blood loss reduction by aprotinin and aminocaproic acid were too heterogeneously distributed to be pooled, so the effect on blood loss could not be evaluated. Both aprotinin and tranexamic acid significantly reduced packed red cell transfusion (4 mL/kg, 95% CI 2-7 mL/kg and 7 mL/kg, 95% CI 5-10 mL/kg, respectively). Type of antifibrinolytic was not a determining factor that explained differences in outcome among trials in a meta-regression analysis. In the scoliosis studies, aprotinin and tranexamic acid significantly reduced blood loss compared with placebo (385 mL, 95% CI 727-42 mL and 682 mL, 95% CI 1149-214 mL, respectively). CONCLUSIONS: There is no evidence that suggests that, compared with aprotinin, alternative antifibrinolytics such as tranexamic acid were less effective in reducing blood loss in major pediatric surgery.
Authors: Priscilla S Briquez; Kristen M Lorentz; Hans M Larsson; Peter Frey; Jeffrey A Hubbell Journal: Biomaterials Date: 2017-04-29 Impact factor: 12.479
Authors: Tom Bowen; Marco Cicardi; Henriette Farkas; Konrad Bork; Hilary J Longhurst; Bruce Zuraw; Emel Aygoeren-Pürsün; Timothy Craig; Karen Binkley; Jacques Hebert; Bruce Ritchie; Laurence Bouillet; Stephen Betschel; Della Cogar; John Dean; Ramachand Devaraj; Azza Hamed; Palinder Kamra; Paul K Keith; Gina Lacuesta; Eric Leith; Harriet Lyons; Sean Mace; Barbara Mako; Doris Neurath; Man-Chiu Poon; Georges-Etienne Rivard; Robert Schellenberg; Dereth Rowan; Anne Rowe; Donald Stark; Smeeksha Sur; Ellie Tsai; Richard Warrington; Susan Waserman; Rohan Ameratunga; Jonathan Bernstein; Janne Björkander; Kristylea Brosz; John Brosz; Anette Bygum; Teresa Caballero; Mike Frank; George Fust; George Harmat; Amin Kanani; Wolfhart Kreuz; Marcel Levi; Henry Li; Inmaculada Martinez-Saguer; Dumitru Moldovan; Istvan Nagy; Erik W Nielsen; Patrik Nordenfelt; Avner Reshef; Eva Rusicke; Sarah Smith-Foltz; Peter Späth; Lilian Varga; Zhi Yu Xiang Journal: Allergy Asthma Clin Immunol Date: 2010-07-28 Impact factor: 3.406