Aprotinin use during cardiac surgery: recent alterations and effects on blood product utilization

J Clin Anesth. 2009 Nov;21(7):502-7. doi: 10.1016/j.jclinane.2008.12.021.

Abstract

Objective: To investigate a single institution's changing use of aprotinin and subsequent effects on intraoperative blood product utilization (red blood cells/fresh frozen plasma) and postoperative clinical bleeding requiring reoperation.

Design: Retrospective study.

Setting: Single university institution (University of Chicago).

Measurements: Data from 499 adult patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) over a two-year period (February 2005 - January 2007) were reviewed. The first 12 months (Feb 2005 - Jan 2006, Group 2005-2006) of data were compared with that from the second 12-month period (Feb 2006 - Jan 2007, Group 2006-2007). Information regarding patient demographics, surgical procedures, aprotinin use (none, half-dose, full-dose), and blood product use during CPB was retrospectively retrieved and analyzed.

Main results: When Group 2006-2007 data was compared with that from Group 2005-2006, full-dose aprotinin use had significantly decreased (58% to 17%, P < 0.001), non-use of aprotinin significantly increased (18% to 47%, P < 0.001), while fresh frozen plasma (FFP) utilization during CPB significantly increased (24% to 36%, P = 0.004). Red blood cell (RBC) transfusion rates remained stable (67% - 69%) yet rates of RBC and FFP transfusion during CPB significantly increased (23% to 34%, P = 0.003). There was also a trend toward increased unplanned reoperations for excessive clinical bleeding (0 pts in Group 2005-2006, three pts in Group 2006-2007).

Conclusions: As the institution's use of high-dose aprotinin has significantly decreased, the number of patients requiring FFP and FFP/RBC combinations during CPB has significantly increased. Furthermore, a trend toward increasing incidence of unplanned reoperations for excessive clinical bleeding was noted.

MeSH terms

  • Aged
  • Aprotinin* / administration & dosage
  • Aprotinin* / adverse effects
  • Aprotinin* / therapeutic use
  • Blood Loss, Surgical / statistics & numerical data
  • Cardiac Surgical Procedures*
  • Cardiopulmonary Bypass
  • Drug Utilization
  • Erythrocyte Transfusion / statistics & numerical data*
  • Female
  • Hospitals
  • Humans
  • Intraoperative Care
  • Male
  • Middle Aged
  • Organizational Policy
  • Plasma*
  • Reoperation / statistics & numerical data
  • Retrospective Studies

Substances

  • Aprotinin