Use of aprotinin in cardiac surgery: effectiveness and safety in a population-based study

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Objective: The effectiveness and safety of aprotinin use in cardiac surgery have been questioned. More data reflecting everyday clinical practice from large-scale, unselected populations are needed. We compared the effectiveness and safety of aprotinin in cardiac surgery with those of tranexamic acid in a follow-up study using the population-based Danish health-care databases. Methods: We identified a total of 3535 patients who underwent cardiac surgery at the Aarhus University Hospital, Skejby, between 1 January 2003 and 31 December 2006; of these, 635 patients were treated with aprotinin and 2900 with tranexamic acid. We used propensity score matching to match aprotinin-treated patients with tranexamic-acid-treated patients in a 1:1 ratio, followed by Poisson regression analysis to compute relative risks (RRs). Results: Patients treated with aprotinin had more severe preoperative risk profiles than the tranexamic-acid-treated patients. The rates of postoperative drainage and transfusion of red blood cells were similar in the two groups, whereas the aprotinin group received plasma (adjusted RR = 1.39; 95% confidence interval (CI): 1.15-1.68) and platelets (adjusted RR = 1.47; 95% CI: 1.19-1.81) more frequently than the tranexamic acid group. There were no statistically significant differences in risks of re-operation due to bleeding (adjusted RR = 1.22; 95% CI: 0.84-1.78), 30-day mortality (adjusted RR = 1.03; 95% CI: 0.69-1.54), acute myocardial infarction (adjusted RR = 1.06; 95% CI: 0.69-1.64), stroke (adjusted RR = 1.36; 95% CI: 0.75-2.44) or composite major event (adjusted RR = 1.14; 95% CI: 0.87-1.50) between the two groups. However, patients who received aprotinin had an increased risk of postoperative dialysis (adjusted RR = 1.76; 95% CI: 1.15-2.70). Conclusions: Aprotinin treatment was associated with an increased use of plasma and platelet transfusion and an increased risk for postoperative dialysis, but not with other adverse outcomes, including short-term mortality. © 2009 European Association for Cardio-Thoracic Surgery.




Jakobsen, C. J., Søndergaard, F., Hjortdal, V. E., & Johnsen, S. P. (2009). Use of aprotinin in cardiac surgery: effectiveness and safety in a population-based study. European Journal of Cardio-Thoracic Surgery, 36(5), 863–868.

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