October 15, 1995Circulation
A Multicenter, Double-Blind, Placebo-Controlled Trial of Aprotinin for Reducing Blood Loss and the Requirement for Donor-Blood Transfusion in Patients Undergoing Repeat Coronary Artery Bypass Grafting
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Discussion
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Implication
Randomized double-blind trial reveals aprotinin reduces blood transfusions during repeat coronary artery bypass grafting, indicating improved blood conservation without higher heart attack risk.
Key Points
- To evaluate the safety and dose-related efficacy of aprotinin in reducing blood loss and donor-blood transfusion requirements in patients undergoing repeat coronary artery bypass graft surgery.
- Prospective, multicenter, double-blind, placebo-controlled trial including N=287 patients undergoing repeat coronary artery bypass graft (CABG) surgery.
- Participants were randomly assigned to high-dose aprotinin, low-dose aprotinin, pump-prime-only aprotinin, or placebo.
- Outcomes measured included donor red-blood-cell (RBC) transfusions up to postoperative day 12, thoracic-drainage volume, total blood-product exposures, and perioperative myocardial infarction.
- Donor RBC transfusion rates were significantly reduced in the high-dose (54%) and low-dose (46%) aprotinin arms compared to pump-prime-only (72%) and placebo (75%) (overall P = .001).
- Mean donor RBC units transfused were significantly lower with high-dose (1.6 ± 0.2 U) and low-dose (1.6 ± 0.3 U) aprotinin compared to pump-prime-only (2.5 ± 0.3 U) and placebo (3.4 ± 0.5 U; P = .0001).
- Total blood-product exposures were reduced (high-dose: 2.2 ± 0.4 U; low-dose: 3.4 ± 0.9 U; pump-prime-only: 5.1 ± 0.9 U; placebo: 10.3 ± 1.4 U), while the incidence of perioperative myocardial infarction showed no significant difference among groups.
Cite This Study
Levy et al. (1995) studied this question.