[Antifibrinolytic agents and repeat open-heart surgery: a comparison of tranexamic acid and low dose aprotinin].

PURPOSE: This retrospective study has for objective to compare the effect of tranexamic acid with low-dose of aprotinin therapy on blood loss in reoperative cardiac surgery.

METHODS: Ninety-one adult patients underwent repeated open-heart surgery. Two groups of patients were collected. The aprotinin group AP (N=60) has received an intravenous full low dose of 500000 UIK of aprotinin. The tranexamic group TA (N=31) has received 30 mg/kg of tranexamic acid. Criteria for assessment included: cumulative blood loss at 4 hours and 20 hours after operation, need for transfusion and parameters of coagulation (platelet, fibrinogen count).

RESULTS: Demographics characteristics and echocardiographic data were similar between the tow groups. Postoperative blood loss at 4th hour and at 20th hour were reduced in tranexamic group compared with aprotinin group (P=0,009, P=0,001). The transfusion requirement was frequent in the AP group 39% vs 19.4% in TA group. The TA group received fewer total unit of red blood (0.38 unit RBC/patient vs 1.06 in AP group) [RBC=red blood cells]. There was no statistically significant difference in platelet and fibrinogen profiles.

CONCLUSION: This study concludes that tranexamic acid and low dose aprotinin effectively reduces postoperative bleeding in repeat open-heart surgery. However, the marked difference in superiority between these tow drug therapies needs the randomized and controlled study.