Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

Bridges, Charles R.

doi:10.1161/circulationaha.107.706598

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…Significant bleeding, especially during redo valve surgery that needs re-exploration and/or requires blood transfusion, increases morbidity and mortality [6].…”

Section: Discussionmentioning

confidence: 99%

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Redo Cardiac Surgery: Bleeding Control

Seghrouchni¹,

Bamous²,

Moutakiallah³

et al. 2017

WJCD

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Redo cardiac surgery increases mortality and morbidity. The aim of this study was to determine if aprotinin was superior to tranexamic acid concerning control bleeding loss after redo valve surgery. A retrospective study was conducted from January 1994 until December 2014. 221 patients underwent redo cardiac valve surgery and separated into two groups: aprotinin group (n = 85) and tranexamic acid group (n = 136). Univariate tests were applied for data analysis. A total of 221 patients were enrolled in this study. This cohort was separated into two groups: aprotinin group (n = 85) and tranexamic acid group (n = 136). Euroscore in tranexamic acid group was higher: 5.96 ± 3.04 vs. 5.17 ± 2.83 in aprotinin group (p = 0.055). There was no statistical difference in postoperative mortality between the two groups (p = 0.153). No statistical differences were reported concerning: total blood loss (p = 0.51), red blood cells transfusion (p = 0.215), reexploration for bleeding (p = 0.537) and postoperative renal failure (p = 0.79). There were statistical differences concerning mechanical ventilation time, which is longer in tranexamic acid group (p = 0.008) and the use of inotropic drug support, which is more frequent in the tranexamic acid group (p = 0.001). Our results demonstrated that tranexamic acid and aprotinin reduce transfusion requirement and blood loss. Due to financial reason, we chose tranexamic acid in preventing blood loss in redo valve surgery.

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“…Significant bleeding, especially during redo valve surgery that needs re-exploration and/or requires blood transfusion, increases morbidity and mortality [6].…”

Section: Discussionmentioning

confidence: 99%

“…Bridges et al found that re-exploration for control of bleeding after cardiac surgery increased four-fold mortality and sternal infection [6].…”

mentioning

confidence: 99%

Redo Cardiac Surgery: Bleeding Control

Seghrouchni¹,

Bamous²,

Moutakiallah³

et al. 2017

WJCD

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show abstract

“…Despite the fact that high-dose aprotinin is perhaps the most efficient drug we have to combat bleeding following cardiac surgery, the accumulating evidence that its use is associated with detrimental microembolic effects is difficult to ignore [10,11]. However, as use of aprotinin decreases, one expects use of other agents (aminocaproic acid, tranexamic acid, desmopressin, and recombinant factor VIIa) to increase.…”

Section: Discussionmentioning

confidence: 99%

“…There is emerging evidence that increased use of such products in patients undergoing cardiac surgery increases morbidity and mortality [9,[13][14][15], perhaps by initiating transfusion-related acute lung injury (TRALI) and/or transfusion-associated cardiac overload (TACO). Furthermore, with decreasing use of high-dose aprotinin, the number of patients brought back to the operating room for re-exploration secondary to excessive bleeding will likely increase [10,11]. This is clinically important because such re-exploration quadruples the risk of sternal infection and mortality [11].…”

Section: Discussionmentioning

confidence: 99%

“…One would anticipate that as aprotinin use decreased, the need/use of red blood cells (RBC), platelets (PLT), fresh frozen plasma (FFP), etc., would increase. This practice, however, may be trading one set of risks (aprotinin) for another (blood products, increased risk of reoperation for bleeding), as emerging evidence indicates that administering blood products to patients undergoing cardiac surgery adversely affects outcome [9] and decreasing use of full-dose aprotinin may increase risk of reoperation for excessive bleeding, thus increasing mortality [10,11].…”

Section: Introductionmentioning

confidence: 99%

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