Living without aprotinin: the results of a 5-year blood saving program in cardiac surgery

• Published in: Acta anaesthesiologica Scandinavica Vol. 53; no. 5; pp. 573 - 580
• Main Authors: RANUCCI, M., CASTELVECCHIO, S., ROMITTI, F., ISGRÒ, G., BALLOTTA, A., CONTI, D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2009; Blackwell
• Subjects: Adult; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - therapeutic use; Antifibrinolytic Agents - therapeutic use; Aprotinin - adverse effects; Biological and medical sciences; Blood Coagulation - physiology; Blood Loss, Surgical - prevention & control; Blood Transfusion - statistics & numerical data; Cardiac Surgical Procedures; Coronary Artery Bypass; Databases, Factual; Drug Utilization; Female; Hemostasis; Heparin - therapeutic use; Humans; Intensive Care Units; Intraoperative Care; Male; Medical sciences; Middle Aged; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - therapy; Retrospective Studies; Thrombelastography; Tranexamic Acid - therapeutic use; Young Adult; Peptidases; Enzyme; Surgery; Enzyme inhibitor; Hydrolases; Anesthesia; Aprotinin; Antifibrinolytic
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2008.01899.x

Background: After 20 years of regular use in cardiac surgery patients, aprotinin has recently been withdrawn from the market due to many concerns about its safety. For a number of reasons aprotinin has not been available in Italy since 1998. The present study presents an aprotinin‐free treatment protocol applied at our institution during the last 5 years, and aims to verify the results of this protocol in terms of allogeneic blood product transfusions, postoperative blood loss and surgical re‐exploration rate. Methods: Retrospective study on 7988 consecutive patients who underwent cardiac surgery during the years 2003–2007. All the patients received specific hemostasis/coagulation management based on (a) routine use of tranexamic acid, (b) heparin dose–response monitoring, thromboelastography, platelet (PLT) function analysis in a select population of patients, and (c) use of fresh frozen plasma (FFP), PLTs, and desmopressin according to the hemostasis/coagulation profile. Data retrieved from the institutional database were quantity of packed red cells (PRCs), FFP, PLT transfusion rate, blood loss in the first 12 postoperative hours, and surgical re‐exploration rate. Results: PRCs were transfused in 40.4% of patients (with higher rates for selected high‐risk subpopulations), FFP in 12.9% and PLTs in 2.6%. Surgical re‐exploration rate was 3.7%. With respect to historical controls, a significant reduction of PRCs and FFP transfusions was obtained using closed circuits, point of care coagulation tests, and combination of the two. Conclusion: This aprotinin‐free blood saving program is an effective strategy for allogeneic blood products transfusion containment.