Low-dose aprotinin in cardiac operations.

Background: Patients with heart disease are frequently maintained on a regimen of aspirin. During cardiac surgery aspirin-induced platelet dysfunction increases the risk of bleeding.

Methods: The files of 82 patients who had undergone open-heart surgery were selected to study the efficacy of the low-dose (2 million KIU) aprotinin regimen in decreasing blood loss and transfusion requirements for patients receiving aspirin. Patients were divided into three groups: Group 1, includes those who received neither aspirin nor aprotinin (n = 41), Group 2, received both aspirin and aprotinin (n = 27) and Group 3, did not receive aprotinin despite aspirin intake (n = 14). Primary outcome measures in this study were total volume of blood loss (postoperative chest tube drainage) and volume of transfusions during hospitalization.

Results: Patients treated with aprotinin (Group 2) had significantly lower total blood loss (359 ml versus 527 ml and 628 ml in Group 1 and Group 3, p < 0.05), rates of bleeding (17.2 ml/hr versus 25.7 and 30.4 ml/hr in groups 1 and 3 respectively). A significant difference was also found when comparing the volume of blood transfusions (224.4 ml versus 262.4 and 537.5 ml) and prevalence of transfusion (33.3% versus 36.6% and 64.3%).

Conclusion: Low-dose aprotinin significantly reduces blood loss and blood transfusions in patients receiving aspirin who undergo cardiac operations.