Abstract
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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 170-177 |
| Number of pages | 8 |
| Journal | Journal of Cardiothoracic and Vascular Anesthesia |
| Volume | 32 |
| Issue number | 1 |
| Early online date | 23 Jun 2017 |
| DOIs | |
| Publication status | Published - 1 Feb 2018 |
Structured keywords
- Centre for Surgical Research
Keywords
- antifibrinolytic agents
- aprotinin
- bleeding
- outcomes
- survival rate
- thoracic aortic surgery