Comparison of the efficacy and safety of aprotinin and tranexamic acid in cardiac surgery with cardiopulmonary bypass in adult patients

Abstract

The objective was to compare the efficacy and safety of the use of aprotinin and tranexamic acid in cardiac surgery with cardiopulmonary bypass (CPB) in adult patients.Materials and methods. A randomized prospective comparative study was conducted. A total of 62 patients were included who underwent cardiac surgery with CPB. In order to prevent bleeding, fibrinolysis inhibitors were used intraoperatively in all patients, depending on the drug used, two groups were formed: «tranexamic acid» (n = 32) and «aprotinin» (n = 30). The time of the operation, the time of CPB and anoxia were recorded, postoperative blood loss according to 12-hour intervals and the need for transfusion during and after surgery were assessed. In the postoperative period, the need for inotropic support at the time of transfer to the intensive care unit (inotropic index), time of ALV, kidney (GFR, creatinine) and liver (ALT, direct bilirubin) function, as well as markers of the inflammatory response (white blood cell count, C-RP) were taken into account.Results. The volume of postoperative blood loss for 12 hours, as well as the need for transfusion in the intraoperative period, did not differ in the studied groups. At the same time, a decrease in the need for erythrocyte suspension was detected in the «aprotinin» group in the early postoperative period (p = 0.02). In the «aprotinin» group, the white blood cell count was higher than in the «tranexamic acid» group (p = 0.02), while the C-RP level was significantly lower in the “aprotinin” group (p = 0.002). The values of the PaO2 /FiO2 ratio in the studied groups did not differ, and the time of ALV was significantly lower in the «aprotinin» group (p = 0.016). Conclusion. The results of the study showed that the use of aprotinin during cardiac surgery with CPB reduces the need for transfusion of hemocomponents in the early postoperative period; no side effects were detected when using the drug.

Keywords

• bleeding
• fibrinolysis inhibitors
• aprotinin
• tranexamic acid
• cardiopulmonary bypass
• cardiac surgery