Efficacy and Safety of Administering Fibrinolysis Inhibitors During Repeat Cardiac Surgery

Aprotinin, a serine protease inhibitor, and tranexamic acid, a synthetic lysine analogue, are both used in cardiac surgery to reduce blood loss and transfusion of blood products. Concern has arisen that the routine use of these agents might lead to an increased incidence of intravascular thrombosis and graft occlusion; however, a clear pattern of adverse effects has not been established. This study reviews the administration of antifibrinolytic agents to patients undergoing repeat cardiac surgery at Baylor University Medical Center. The efficacy and safety of these agents were assessed in 125 consecutive patients who were divided into 3 groups: those receiving aprotinin (n = 42), those receiving tranexamic acid (n = 45), and a control group (n = 38) not given an antifibrinolytic agent. This study showed that the control group experienced significantly greater chest tube drainage than the treated groups. The aprotinin and tranexamic acid groups required less fresh frozen plasma than the control group, and the tranexamic acid group required fewer units of packed red cells and cryoprecipitate than either the aprotinin or control groups. On retrospective review, tranexamic acid may be more efficacious than aprotinin in reducing blood transfusion requirements in repeat cardiac surgery.