Bleeding in cardiac surgery: The use of aprotinin does not affect survival

Objective

The antifibrinolytic drug aprotinin has been the most widely used agent to reduce bleeding and its complications in cardiac surgery. Several randomized trials and meta-analyses have demonstrated it to be effective and safe. However, 2 recent reports from a single database have implicated the use of aprotinin as a risk for postoperative complications and reduced long-term survival.

Methods

In this single-institution observational study involving 7836 consecutive patients (1998–2006), we assessed the safety of using aprotinin in risk reduction strategy for postoperative bleeding.

Results

Aprotinin was used in 44% of patients. Multivariate analysis identified aprotinin use in risk reduction for reoperation for bleeding (odds ratio, 0.51; 95% confidence interval, 0.36–0.72; P = .001) and need for blood transfusion postoperatively (odds ratio, 0.67; 95% confidence interval, 0.57–0.79; P = .0002). The use of aprotinin did not affect in-hospital mortality (odds ratio, 1.03; 95% confidence interval, 0.71–1.49; P = 0.73), intermediate-term survival (median follow-up, 3.4 years; range, 0–8.9 years; hazard ratio, 1.09; 95% confidence interval, 0.93–1.28; P = .30), incidence of postoperative hemodialysis (odds ratio, 1.16; 95% confidence interval, 0.73–1.85; P = .49), and incidence of postoperative renal dysfunction (odds ratio, 0.78; 95% confidence interval, 0.59–1.03; P = .07).

Conclusion

This study demonstrates that aprotinin is effective in reducing bleeding after cardiac surgery, is safe, and does not affect short- or medium-term survival.

CTSNet classification: 16, 18

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CI, confidence interval, GFR, glomerular filtration rate, KIU, kallikrein inhibitor units