Use of aprotinin in cardiac surgery: effectiveness and safety in a population-based study
Research output: Contribution to journal › Journal article › Research › peer-review
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.
Original language | English |
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Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery |
Volume | 36 |
Issue number | 5 |
Pages (from-to) | 863-8 |
Number of pages | 6 |
ISSN | 1010-7940 |
DOIs | |
Publication status | Published - Nov 2009 |
- Acute Kidney Injury/chemically induced, Aged, Aged, 80 and over, Aprotinin/adverse effects, Blood Component Transfusion, Cardiac Surgical Procedures, Drug Evaluation, Epidemiologic Methods, Female, Hemostasis, Surgical/methods, Hemostatics/adverse effects, Humans, Male, Middle Aged, Perioperative Care/methods, Postoperative Hemorrhage/prevention & control, Renal Dialysis, Tranexamic Acid/adverse effects, Treatment Outcome
Research areas
ID: 242714248