Changing from Aprotinin to Tranexamic Acid Results in Increased Use of Blood Products and Recombinant Factor VIIa for Aortic Surgery Requiring Hypothermic Arrest

Objective: Aprotinin, once used to reduce allogeneic blood product transfusion during cardiac surgery, was withdrawn from the market in late 2007 over concerns of causing increased mortality. This study was undertaken to determine what, if any, the impact of changing antifibrinolytic agents (from aprotinin to tranexamic acid) for deep hypothermic circulatory arrest cases would have on blood bank resource utilization. Design: This a retrospective review. Setting: All cases were performed at a single university hospital. Participants: All patients underwent cardiac surgical procedures requiring deep hypothermic circulatory arrest performed by a single cardiac surgeon between January 2006 and November 2008. Intervention: All patients prior to November 15, 2007 received aprotinin as antifibrinolytic therapy, while those after that date received tranexamic acid for antifibrinolytic therapy. Measurements and Main Results: Blood transfusion data and recombinant factor Vila use during the pre- and immediate postoperative period was collected for all patients during the study time period. There were no significant differences between the aprotinin (n = 82) and tranexamic acid (n = 78) groups with regard to baseline coagulation status or operative characteristics. Patients treated with tranexamic acid required more fresh frozen plasma (2.5 units, p < 0.001), platelets (0.5 units, p < 0.01), and cryoprecipitate (25 units, p < 0.001), and had a higher incidence of recombinant factor Vila use (34.6% v 12.2%, p < 0.01) compared with patients in the aprotinin group. Conclusions: Patients treated with tranexamic acid required more clotting factors than the control group receiving aprotinin. (C) 2010 Elsevier Inc. All rights reserved.