Effectiveness and Safety of Aprotinin Use in Thoracic Aortic Surgery

Objective

To compare the effectiveness and safety of aprotinin use in adult patients undergoing thoracic aortic surgery.

Design

Single center retrospective study.

Setting

All cases performed at a single university hospital.

Participants

Between January 2004 and December 2014, 846 adult patients underwent thoracic aortic surgery. Due to missing or duplicated data on primary outcomes, 314 patients were excluded. The final sample of 532 patients had operations on the thoracic aorta.

Intervention

The patients were divided in two groups: a total of 107 patients (20.1%) received aprotinin during the operation representing the study group, while the remaining 425 patients (79.9%) underwent surgery without the use of aprotinin.

Measurements and Main Results

To adjust for patient selection and preoperative characteristics, a propensity score-matched analysis was conducted. Mean total blood loss at 12 hours after surgery was similar between the two groups. The blood product transfusion rates did not differ in the two groups apart for the rate of fresh frozen plasma transfusion, being significantly higher in the aprotinin group. Re-exploration for bleeding and the incidence of a major post-operative bleeding event were similar between the groups. In-hospital mortality, renal failure and cerebrovascular accidents did not show any statistically significant difference. Aprotinin did not represent a risk factor for mortality over the long term outcome (HR 1.14, 95%CI 0.62-2.08, p=0.66).

Conclusions

The use of aprotinin demonstrated a limited effect in reducing post-operative bleeding and prevention of major bleeding events. Aprotinin did not adversely affect early outcomes and long term survival.