Abstract 9456: Early Postoperative Outcomes and Blood Product Utilization in Adult Cardiac Surgery: The Post-Aprotinin Era
Background: Strategies to improve coagulation through targeting the fibrinolytic cascade have been a pharmacological mainstay in cardiac surgery. With the suspension of aprotinin, alternatives such as the lysine analogues (tranexamic acid; TXA or epsilon aminocaproic acid; EACA) are being used. This study tested the hypothesis that when adjusted for pre-operative risk variables, early post-operative adverse events and blood product utilization would actually be higher in this current post-aprotinin era.
Methods/Results: Adult patients (n=781) undergoing coronary artery bypass (CABG), valve replacement, at a single institution were included whereby multiple logistic regression modeling and propensity scoring were performed on 28 pre-operative and intra-operative variables. Following adjustment for confounding influences on patients receiving aprotinin (n=325) or lysine analogues (TXA; n=456; EACA; n=250), the adjusted relative risk (RR;95% Confidence Interval; CI)) for early post-operative mortality (RR:0.53;CI:0.19–1.49) or neurological events (RR:1.00;CI:0.38–2.62), were similar between groups, as were all major adverse cardiac and cerebrovascular events. The risk for renal dysfunction (RR:0.58;CI:0.31–1.10) was lower in the aprotinin group (p<0.05). The RR for the intra-operative use of fresh frozen plasma, cryoprecipitate and the use of recombinant Factor VIIa were significantly lower in the aprotinin group (Figure).
Conclusions: In the post-aprotinin era with the exclusive use of lysine analogues, the relative risk of early post-operative outcomes such as mortality and renal dysfunction have not improved. The intra-operative use of blood products has increased in this post-aprotinin era. Thus, improvements in early post-operative outcomes have not been realized with the discontinued use of aprotinin, but rather increased blood product utilization has occurred with the attendant costs and risks inherent with this strategy.
- © 2010 by American Heart Association, Inc.