Combination of Acute Preoperative Plateletpheresis, Cell Salvage, and Aprotinin Minimizes Blood Loss and Requirement During Cardiac Surgery

Abstract

Acute preoperative plateletpheresis (APP), cell salvage (CS) technique, and the use of aprotinin have been individually reported to be effective in reducing blood loss and blood component transfusion while improving hematological profiles in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this prospective randomized clinical study, the efficacy of these combined approaches on reducing blood loss and transfusion requirements was evaluated. Seventy patients undergoing primary coronary artery bypass grafting (CABG) were randomly divided into four groups: a control group (group I, n = 10) did not receive any of the previously mentioned approaches. An APP and CS group (group II, n = 20) experienced APP in which preoperative platelet-rich plasma was collected and reinfused after reversal of heparin, along with the cell salvage technique throughout surgery. The third group (group III, n = 22) received aprotinin in which 5,000,000 KIU Trasylol was applied during surgery, and a combination group (group IV, n = 18) was treated with all three approaches, i.e., APP, CS, and aprotinin. Compared with group I (896 ± 278 mL), the postoperative total blood loss was significantly reduced in groups II, III, and IV (468 ± 136,388 ± 122,202 ± 81 mL, respectively, p < 0.05). The requirements of packed red blood cells in the three approached groups (153 ± 63,105 ± 178,0 ± 0 mL, respectively) also were reduced when compared with group I (343 ± 118 mL, p < 0.05). In group I, six patients (6/10) received fresh-frozen plasma and three patients (3/10) received platelet transfusion, whereas no patients in the other three groups required fresh-frozen plasma and platelet. In conclusion, both plateletpheresis concomitant with cell salvage and aprotinin contribute to the improvement of postoperative hemostasis, and the combination of these two approaches could minimize postoperative blood loss and requirement.

Efficacy of autologous plateletpheresis in adult aortic surgery: study protocol for a randomised controlled trial

“…Then in 1987, Ferrari et al 27 performed perioperative plasmapheresis to collect aPRP and demonstrated a reduction in blood loss and the need for allogeneic blood transfusion. Since then, APP has been widely used in cardiovascular surgery because it sets aside a subset of the patient’s own platelets from the circulation during surgery and prevents exposure of that platelet subset to the CPB circuit, decreasing the risk of global platelet dysfunction 8 9 28. The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists recommended in 201129 that APP may be a reasonable approach to support blood conservation strategies in high-risk patients if an adequate yield can be reliably obtained (class IIa, level of evidence A).…”