Head of Cardiovascular SurgeryWard, Shaheed Rajaiee Cardiovascular, Medical and Research Center, Tehran, Iran
Background: Cardiovascular operations are associated with an inherent bleeding tendency that sometime leads to severe bleeding and transfusion requirement. Pharmacologic intervention to minimize post-bypass bleeding and blood product transfusions has received increasing attention for both medical and economic perspectives.
Methods: In this double-blind, randomized, placebo-controlled clinical trial, three groups of patients, each comprising 50 patients undergoing on-pump coronary artery bypass grafting surgery (CABG) were blindly randomized to receive either low aprotinin, tranexamic acid, or placebo, the results were subsequently evaluated and compared between the groups.
Results: The following variables were similar in the groups, and there were no statistically significant differences in these variables: age (p value=0.308), sex (p value=0.973), hyperlipidemia (p value=0.720), hypertension (p value=0.786), smoking (p value=0.72), and diabetes (p value=0.960). The amounts of drainage from chest tubes were less in the aprotinin and tranexamic acid groups compared to the placebo group, and this was statistically significant (p value<0.001). There was no statistically significant difference in need for reoperation for bleeding between the three groups (p value=0.998). Complications following surgery in the three groups were statistically the same and not significantly different (Table below). All the complications had a good course, and all the patients were discharged from hospital uneventfully. There was no mortality in any group.
Conclusions: Low-dose aprotinin and tranexamic acid can significantly reduce blood loss and transfusion requirement in CABG without importantly increasing mortality and morbidity.