Living without aprotinin: The results of a 5-year blood saving program in cardiac surgery

M. Ranucci, S. Castelvecchio, F. Romitti, G. IsgrÒ, A. Ballotta, D. Conti

Research output: Contribution to journalArticle

Abstract

Background: After 20 years of regular use in cardiac surgery patients, aprotinin has recently been withdrawn from the market due to many concerns about its safety. For a number of reasons aprotinin has not been available in Italy since 1998. The present study presents an aprotinin-free treatment protocol applied at our institution during the last 5 years, and aims to verify the results of this protocol in terms of allogeneic blood product transfusions, postoperative blood loss and surgical re-exploration rate. Methods: Retrospective study on 7988 consecutive patients who underwent cardiac surgery during the years 2003-2007. All the patients received specific hemostasis/coagulation management based on (a) routine use of tranexamic acid, (b) heparin dose-response monitoring, thromboelastography, platelet (PLT) function analysis in a select population of patients, and (c) use of fresh frozen plasma (FFP), PLTs, and desmopressin according to the hemostasis/coagulation profile. Data retrieved from the institutional database were quantity of packed red cells (PRCs), FFP, PLT transfusion rate, blood loss in the first 12 postoperative hours, and surgical re-exploration rate. Results: PRCs were transfused in 40.4% of patients (with higher rates for selected high-risk subpopulations), FFP in 12.9% and PLTs in 2.6%. Surgical re-exploration rate was 3.7%. With respect to historical controls, a significant reduction of PRCs and FFP transfusions was obtained using closed circuits, point of care coagulation tests, and combination of the two. Conclusion: This aprotinin-free blood saving program is an effective strategy for allogeneic blood products transfusion containment.

Original languageEnglish
Pages (from-to)573-580
Number of pages8
JournalActa Anaesthesiologica Scandinavica
Volume53
Issue number5
DOIs
Publication statusPublished - May 2009

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Aprotinin
Thoracic Surgery
Hemostasis
Blood Transfusion
Point-of-Care Systems
Thrombelastography
Tranexamic Acid
Postoperative Hemorrhage
Deamino Arginine Vasopressin
Platelet Transfusion
Clinical Protocols
Italy
Heparin
Blood Platelets
Retrospective Studies
Databases
Safety
Population

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Living without aprotinin : The results of a 5-year blood saving program in cardiac surgery. / Ranucci, M.; Castelvecchio, S.; Romitti, F.; IsgrÒ, G.; Ballotta, A.; Conti, D.

In: Acta Anaesthesiologica Scandinavica, Vol. 53, No. 5, 05.2009, p. 573-580.

Research output: Contribution to journalArticle

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