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Eur J Cardiothorac Surg 2007;31:366-371. doi:10.1016/j.ejcts.2006.12.003
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study

^a Department of Cardiac Surgery, University Hospital Dubrava, Zagreb, Croatia
^b Department of Pharmacy, University Hospital Dubrava, Zagreb, Croatia

Received 14 September 2006; received in revised form 4 December 2006; accepted 5 December 2006.

^_* Corresponding author. Tel.: +385 1 290 2530; fax: +385 1 290 3819. (Email: dbaric{at}kbd.hr).

Objective: Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding and transfusion requirements. Methods: In this single-center prospective, randomized, double-blind trial, 300 adult cardiac patients were randomized into three groups to receive one million IU of aprotinin (AP group), 2.5 g of tranexamic acid (TA group) or placebo (PL group) topically before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. Results: Postoperative bleeding within first 12-h period (AP group 433 ± 294 [350; 360] ml, TA group 391 ± 255 [350; 305] ml, PL group 613 ± 505 [525; 348] ml), as well as cumulative blood loss within 24 h (AP group 726 ± 432 [640; 525] ml, TA group 633 ± 343 [545; 335] ml, PL group 903 ± 733 [800; 445] ml), showed statistically significant inter-group differences (both p < 0.001). Bleeding rates values were significantly higher in placebo group compared to the groups treated with antifibrinolytic agents (AP and TA groups) concerning both variables. Although TA group showed the lowest values, no statistical differences between TA and AP groups were found. Inter-group difference of blood product requirements was not statistically significant. Conclusions: Topical use of either tranexamic acid or aprotinin efficiently reduces postoperative bleeding. TA seems to be at least as potent as aprotinin, but potentially safer and with better cost-effectiveness ratio.

Key Words: Cardiac surgery • Postoperative bleeding • Aprotinin • Tranexamic acid

This article has been cited by other articles:

				B. Bidstrup and J. Yellowlees Re: Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 682 - 682. [Full Text] [PDF]

				D. Baric, D. Unic, and B. Biocina Reply to Bidstrup and Yellowlees Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 682 - 683. [Full Text] [PDF]