Ultra-low dose aprotinin effects on reducing the need for blood transfusion in cardiac surgery

OBJECTIVE: To assess the effects of ultra-low dose one million kallikrein inhibitor units (KIU) of aprotinin on bleeding and the need for transfusion after cardiac surgery.

METHODS: We carried out this randomized clinical trial on 162 cardiac surgery patients in Shahid Madani Hospital, Tabriz, Iran from April 2004 to December 2005. The patients were randomly divided into 2 groups of 81 individuals. In the aprotinin group, 0.5 million KIU infused before and 0.5 million KIU during cardiopulmonary bypass. In the placebo group, 100 ml normal saline was infused as above. The need to use fresh frozen plasma (FFP), packed red blood cells (PRBCs) transfusion during, after operation, the rate of chest tubes drainage at 6, 12 and 24 hours after surgery were measured in 2 groups.

RESULTS: Chest tubes drainage at 6 hours after surgery was 190 ± 24 ml in the aprotinin group and 266 ± 33 ml in the placebo group (p=0.066). The amount of bleeding at 12 and 24 hours was significantly different between 2 groups (p=0.048, p=0.009). The frequency of blood products transfusion in the aprotinin group was 68% and in the placebo group was 75% (p=0.02). The number of PRBCs and FFP units transfused were significantly lower in the aprotinin group (p=0.000, p=0.005). Total amount of blood and products transfusion in the aprotinin group was 2.56 ± 0.27 units and in placebo group it was 4.37 ± 0.27 units (p=0.0001).

CONCLUSION: Results indicate that the use of one million KIU of aprotinin in cardiac surgery is effective in reducing postoperative bleeding and transfusion requirements.