Tranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial☆

Abstract

Aprotinin has clinically significant advantages over tranexamic acid in patients with normal renal function scheduled for low- or intermediate-risk cardiac surgery.

Tranexamic acid concentrations associated with human seizures inhibit glycine receptors

“…Aprotinin was studied at lower concentrations, as its potency in terms of antifibrinolytic effect is greater than that of TXA or EACA (46). Aprotinin applied at concentrations as high as 100 μM did not inhibit glycine receptor function ( Figure 4C).…”

The risks associated with aprotinin use: a retrospective study of cardiac cases in Nova Scotia

“…Some researchers suggest that aprotinin is safe depending on patient comorbidities and the surgery type and severity, but even they do not agree on the details and conditions. 6,9,11,31,32 Aprotinin is not available in the USA. Health Canada has recently lifted the ban and approved aprotinin when used as authorized in CABG surgery.…”

“…[3][4][5][6][7][8][9] Numerous studies outlined purported risks of aprotinin use compared with both placebo and the lysine analogues. 9,10 The focus of this retrospective analysis is on elucidation of the safety and efficacy of aprotinin compared with TXA in cardiac surgery.…”

“…At best, tranexamic acid has been shown to be equally as effective as aprotinin at reducing blood loss, and, at worst, it is moderately less effective. [3][4][5][6]8,9,13 Tranexamic acid is more commonly used in low-to medium-risk cardiac cases, presumably due to its lower cost and relatively few reported adverse effects. The majority of studies comparing TXA with aprotinin have shown that TXA is as safe or safer than aprotinin 6,13 ; however, one study has shown that TXA is associated with a higher incidence of seizures, atrial fibrillation, and renal failure when compared with aprotinin.…”

“…9,10 Reported safety concerns with aprotinin primarily include mortality, 5,8,9,11,12 renal failure, 6,12-14 renal dysfunction, 3,15,16 and stroke, 13,15,17 and, to a lesser extent, myocardial infarction. 13 In May 2008, the results of a randomized control trial, Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART), provided the most convincing evidence for the adverse outcomes associated with the use of aprotinin.…”