A comparison of the effects of tranexamic acid and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing cardiac surgery

Objectives:

To assess the relative efficacy of a “low-dose” aprotinin regimen and tranexamic acid on blood loss and homologous blood usage in patients undergoing primary cardiac surgery.

Design:

The trial was prospective, randomized, and controlled.

Setting:

A single center study in a regional cardiothoracic unit in the UK.

Participants:

75 Patients, age 18 years or over, who were scheduled for routine primary cardiac surgery.

Interventions:

The patients were randomly allocated to receive neither drug nor placebo, a total of 5 g of tranexamic acid, or a total of 2 × 10⁶ kallikrein inhibitory units of aprotinin in the perioperative period.

Measurements and Main Results:

The volume of blood loss and blood replacement were measured in the operative and postoperative periods. Hemoglobin concentration, platelet count, and white cell counts were determined preoperatively and at 24 hours postoperatively. Patients receiving tranexamic acid or aprotinin showed a significant reduction in postoperative blood loss (median[interquartile range] 375 mL [252 to 542] and 230 mL [137 to 547]), respectively, compared with the control group (615 mL [430 to 861]). Blood usage was also reduced in patients in both the tranexamic acid group (600 mL [415 to 800]) and the aprotinin-treated group (420 mL [350 to 887]) compared with the control group (1,050 mL [0 to 1,337]). There was no significant difference in blood loss or homologous blood use between patients treated with tranexamic acid or aprotinin.

Conclusions:

Tranexamic acid is as effective as low-dose aprotinin in the reduction of postoperative blood loss and homologous blood transfusion in patients undergoing primary cardiac surgery.