BACKGROUND: Aprotinin is superior to other antifibrinolytic drugs for preventing major blood loss after cardiac surgery but may also increase perioperative mortality. It remains unclear whether its risk-benefit profile differs among low-, moderate-, and high-risk cardiac surgical patients. METHODS: In this retrospective single-center cohort study, we included 15,365 patients who underwent cardiac surgery with cardiopulmonary bypass from 2000 to 2008. Of these, 1017 received aprotinin (6 x 10(6) U) and 14,358 received tranexamic acid (50-100 mg/kg). Propensity score methods were used to create a matched-pairs cohort (n = 1544) that adjusted for important between-group differences. The influence of patients' risk status on aprotinin's association with in-hospital mortality, morbidity, and blood loss was measured. RESULTS: In the matched set, aprotinin was only associated with increased acute kidney injury (> 50% decrease in estimated glomerular filtration or dialysis; odds ratio 1.5; 95% confidence interval [CI] 1.1-2.1). Patients' risk status significantly influenced the associations of aprotinin with mortality, acute kidney injury, and massive blood loss (transfusion of > or = 10 U of red blood cells or need for surgical reexploration). Among high-risk patients, the respective odds ratios were 0.6 (CI 0.3-1.0), 1.1 (CI 0.7-1.7), and 0.7 (CI 0.4-1.04), and among low- to moderate-risk patients, they were 1.5 (CI 0.9-2.7), 2.2 (CI 1.4-3.5), and 1.2 (CI 0.9-1.07) (Breslow-Day test for homogeneity of odds ratios between high-risk versus low- to moderate-risk patients: P < 0.05 for all 3 outcomes). CONCLUSIONS: Aprotinin tends to have a better risk-benefit profile than tranexamic acid in high-risk, but not low- to moderate-risk, patients. Its use in high-risk cases may therefore be warranted.
BACKGROUND: Aprotinin is superior to other antifibrinolytic drugs for preventing major blood loss after cardiac surgery but may also increase perioperative mortality. It remains unclear whether its risk-benefit profile differs among low-, moderate-, and high-risk cardiac surgical patients. METHODS: In this retrospective single-center cohort study, we included 15,365 patients who underwent cardiac surgery with cardiopulmonary bypass from 2000 to 2008. Of these, 1017 received aprotinin (6 x 10(6) U) and 14,358 received tranexamic acid (50-100 mg/kg). Propensity score methods were used to create a matched-pairs cohort (n = 1544) that adjusted for important between-group differences. The influence of patients' risk status on aprotinin's association with in-hospital mortality, morbidity, and blood loss was measured. RESULTS: In the matched set, aprotinin was only associated with increased acute kidney injury (> 50% decrease in estimated glomerular filtration or dialysis; odds ratio 1.5; 95% confidence interval [CI] 1.1-2.1). Patients' risk status significantly influenced the associations of aprotinin with mortality, acute kidney injury, and massive blood loss (transfusion of > or = 10 U of red blood cells or need for surgical reexploration). Among high-risk patients, the respective odds ratios were 0.6 (CI 0.3-1.0), 1.1 (CI 0.7-1.7), and 0.7 (CI 0.4-1.04), and among low- to moderate-risk patients, they were 1.5 (CI 0.9-2.7), 2.2 (CI 1.4-3.5), and 1.2 (CI 0.9-1.07) (Breslow-Day test for homogeneity of odds ratios between high-risk versus low- to moderate-risk patients: P < 0.05 for all 3 outcomes). CONCLUSIONS: Aprotinin tends to have a better risk-benefit profile than tranexamic acid in high-risk, but not low- to moderate-risk, patients. Its use in high-risk cases may therefore be warranted.
Authors: Eric M Graham; Andrew M Atz; Jenna Gillis; Stacia M Desantis; A Lauren Haney; Rachael L Deardorff; Walter E Uber; Scott T Reeves; Francis X McGowan; Scott M Bradley; Francis G Spinale Journal: J Thorac Cardiovasc Surg Date: 2011-11-09 Impact factor: 5.209
Authors: Stacia M DeSantis; J Matthew Toole; John M Kratz; Walter E Uber; Margaret J Wheat; Martha R Stroud; John S Ikonomidis; Francis G Spinale Journal: Circulation Date: 2011-09-13 Impact factor: 29.690
Authors: Colin R Lenihan; Maria E Montez-Rath; Christina T Mora Mangano; Glenn M Chertow; Wolfgang C Winkelmayer Journal: Ann Thorac Surg Date: 2012-12-25 Impact factor: 4.330