Antifibrinolytic agents in off-pump cardiac surgery: analysis of blood loss, safety and cost-effectiveness

Overview

Objective:
To compare the haemostatic effects of fibrinolytic inhibitors (tranexamic acid, aprotinin) vs. placebo in off-pump coronary artery bypass surgery and to evaluate the impact of this therapy on cost-effectiveness.

Design:
Prospective, randomized, double-blind study.

Setting:
University Teaching Hospital, Prague, Czech Republic.

Material and Method:
100 patients were enrolled in the study and 91 of them were assessed (group A, n = 32, tranexamic acid 1 g before skin incision followed by continuous infusion at 200 mg/h; group B, n = 29, aprotinin 1,000,000 IU before skin incision and 250,000 IU/h afterwards; group C, n = 30, placebo).

Results:
Highly significant inter-group differences were found in the cumulative blood loss within 4 h (geometric means [95% confidence intervals] –⁠ group A: 89.3 [72.7, 109.8] mL, group B: 72.3 [49.2, 106.3] mL and group C: 192.3 [151.8, 243.5] mL) (P

Conclusion:
Both tranexamic acid and aprotinin seem to be similarly effective in the reduction of postoperative blood loss in off-pump cardiac surgery. Tranexamic acid appears to be a cost-effective and safe alternative to aprotinin.

Key words:
tranexamic acid –⁠ aprotinin –⁠ cardiac surgical procedures –⁠ off-pump coronary artery bypass