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Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary artery bypass grafting
AsiaPacificHeartJ 1999;8(1)
AbstractsOf TheCardiothoracicSection 13th Inter
Annual
Scientijc
Congress,
RACS
Ultra-low Dose Aprotinin Decreaseslkansfusion Requirements And Is Cost Effective In Coronary Artery Bypass Grafting R. Dignan, D. Law, P. Seah,C. Manganas,M. Chesti,H. Wolfenden The Prince of Wales Hospital, Sydney, New South Wales
Background:
Table 1. Transfusion
In addition to being costly, blood transfusions carry the risk of infection and transfusion reaction which are unwarranted in routine CABG. Although the recommended dose of aprotinin has been shown to reduce blood loss and the need for blood transfusions, cost precludes its routine use in CABG. This study was designed to determine whether a less expensive, ultra-low dose of aprotinin is effective when used in CABG with left internal mammary artery (LIMA). Methods: Patients (n=157 with 2 exclusions for surgical bleeding found at re-exploration and 2 excluded during blood bank depletion of platelets) were randomised to receive either placebo or aprotinin (1 x 106 KIU) during LIMA harvest, prior to initiation of cardiopulmonary bypass (CPB). Differences in blood products transfused were analysed using non-parametric analysis of rank sums (Wilcoxon/Kruskal-Wallis test). Further subgroups were analysed to account for the effect of aspirin. An aprotinin-induced reduction in transfusion rate of 1 or more units of blood product was considered cost effective. Results: The proportion of patients transfused in each group was analysed using a chi-square test. Analyses of differences in chest tube drainage and postoperative complications were performed using an independent t-test (Table 1). There was an important reduction in all blood
Total population (n=153) No aspirin* * (n=77) Aspirin*** (n=76)
of all blood products.*
Aprotinin group Placebogroup 1.22 f 0.4 3.65 + 0.54 (n=74) (n=79) 0.64 f 0.19 2.06 f 0.61 (n=42) (n=35) 1.86kO.81 4.54 f 0.82 (n=37) (n=39)
p value 0.004 0.0375 0.004
*Values are mean units of all blood products (packed red blood cells, platelets, and fresh frozen plasma) transfused + the standard error. **Patients who did not receive aspirin within 7 days prior to surgery; ***Patients who received aspirin within 7 days prior to surgery. products transfused when aprotinin was given prior to routine CABG with LIMA. This difference was even more important in patients on aspirin preoperatively. The proportion of patients who received any blood product was less in the aprotinin-treated group. There was a significant reduction in chest-tube drainage in the aprotinin group but no differences between groups in the rate of transient ischaemic attack, stroke, myocardial infarction, rise in creatinine, or acute renal failure. Conclusions: These data support the routine use of 1 million KIU of aprotinin in CABG with LIMA to reduce the cost and risk of infection with each unit of blood transfused.
Is It Safe To Salvage Blood From The Pericardium During Cardiac Surgery? Mark Newman, Matt Sheminant Sir Charles Gairdner Hospital, Perth, Western Australia reduction in 6-hour postoperative blood loss in the group which did not receive any salvaged pericardial blood (265*36 mL vs 582&96 mL, ~~0.003). D-dimers were raised only in the group which received salvaged blood. Plasma-free Hb was 3 times higher in the return group (3.3*g/L vs 0.9*1 g/L, ~~0.02). Postoperative blood product use was similar in both groups and postoperative Hb was also similar despite discarding blood in the nonreturn group. The volume of salvaged blood averaged 483k50 mL with a mean Hb of 68 g/L and free Hb of 28 g/L. This would not warrant routine salvage and washing for cell saving (= 100 mL of blood with Hb of 160). There were no significant differences in inflammatory responses between groups. Conclusions: Salvaged blood from the pericardium activates fibrinolysis and increases blood loss postoperatively. Its volume of viable cells does not warrant the routine use of a cell saver.
Background:
During most cardiac surgical operations, it has been routine to salvage heparinised shed blood from the pericardium and return it to the bypass machine. We investigated whether this may have detrimental effects. Methods: In 30 patients undergoing first-time CABG surgery, the blood salvaged by the cardiotomy sucker was collected and weighed via an in-line reservoir bag. In half the group selected randomly, the blood was not returned to the circulation, while in the other half it was added progressively as collected. The volume and haemoglobin and free-haemoglobin levels of the salvaged blood and its d-dimer level were measured. Also, the patients’ serum-free haemoglobin and d-dimer levels were measured before and after bypass. We measured postoperative blood loss and some indices of systemic inflammatory response (peak temperature, WCC and SVRI). Results: There was a significant
55
AbstractsOf TheCardiothoracicSection 13th Inter
Annual
Scientijc
Congress,
RACS
Ultra-low Dose Aprotinin Decreaseslkansfusion Requirements And Is Cost Effective In Coronary Artery Bypass Grafting R. Dignan, D. Law, P. Seah,C. Manganas,M. Chesti,H. Wolfenden The Prince of Wales Hospital, Sydney, New South Wales
Background:
Table 1. Transfusion
In addition to being costly, blood transfusions carry the risk of infection and transfusion reaction which are unwarranted in routine CABG. Although the recommended dose of aprotinin has been shown to reduce blood loss and the need for blood transfusions, cost precludes its routine use in CABG. This study was designed to determine whether a less expensive, ultra-low dose of aprotinin is effective when used in CABG with left internal mammary artery (LIMA). Methods: Patients (n=157 with 2 exclusions for surgical bleeding found at re-exploration and 2 excluded during blood bank depletion of platelets) were randomised to receive either placebo or aprotinin (1 x 106 KIU) during LIMA harvest, prior to initiation of cardiopulmonary bypass (CPB). Differences in blood products transfused were analysed using non-parametric analysis of rank sums (Wilcoxon/Kruskal-Wallis test). Further subgroups were analysed to account for the effect of aspirin. An aprotinin-induced reduction in transfusion rate of 1 or more units of blood product was considered cost effective. Results: The proportion of patients transfused in each group was analysed using a chi-square test. Analyses of differences in chest tube drainage and postoperative complications were performed using an independent t-test (Table 1). There was an important reduction in all blood
Total population (n=153) No aspirin* * (n=77) Aspirin*** (n=76)
of all blood products.*
Aprotinin group Placebogroup 1.22 f 0.4 3.65 + 0.54 (n=74) (n=79) 0.64 f 0.19 2.06 f 0.61 (n=42) (n=35) 1.86kO.81 4.54 f 0.82 (n=37) (n=39)
p value 0.004 0.0375 0.004
*Values are mean units of all blood products (packed red blood cells, platelets, and fresh frozen plasma) transfused + the standard error. **Patients who did not receive aspirin within 7 days prior to surgery; ***Patients who received aspirin within 7 days prior to surgery. products transfused when aprotinin was given prior to routine CABG with LIMA. This difference was even more important in patients on aspirin preoperatively. The proportion of patients who received any blood product was less in the aprotinin-treated group. There was a significant reduction in chest-tube drainage in the aprotinin group but no differences between groups in the rate of transient ischaemic attack, stroke, myocardial infarction, rise in creatinine, or acute renal failure. Conclusions: These data support the routine use of 1 million KIU of aprotinin in CABG with LIMA to reduce the cost and risk of infection with each unit of blood transfused.
Is It Safe To Salvage Blood From The Pericardium During Cardiac Surgery? Mark Newman, Matt Sheminant Sir Charles Gairdner Hospital, Perth, Western Australia reduction in 6-hour postoperative blood loss in the group which did not receive any salvaged pericardial blood (265*36 mL vs 582&96 mL, ~~0.003). D-dimers were raised only in the group which received salvaged blood. Plasma-free Hb was 3 times higher in the return group (3.3*g/L vs 0.9*1 g/L, ~~0.02). Postoperative blood product use was similar in both groups and postoperative Hb was also similar despite discarding blood in the nonreturn group. The volume of salvaged blood averaged 483k50 mL with a mean Hb of 68 g/L and free Hb of 28 g/L. This would not warrant routine salvage and washing for cell saving (= 100 mL of blood with Hb of 160). There were no significant differences in inflammatory responses between groups. Conclusions: Salvaged blood from the pericardium activates fibrinolysis and increases blood loss postoperatively. Its volume of viable cells does not warrant the routine use of a cell saver.
Background:
During most cardiac surgical operations, it has been routine to salvage heparinised shed blood from the pericardium and return it to the bypass machine. We investigated whether this may have detrimental effects. Methods: In 30 patients undergoing first-time CABG surgery, the blood salvaged by the cardiotomy sucker was collected and weighed via an in-line reservoir bag. In half the group selected randomly, the blood was not returned to the circulation, while in the other half it was added progressively as collected. The volume and haemoglobin and free-haemoglobin levels of the salvaged blood and its d-dimer level were measured. Also, the patients’ serum-free haemoglobin and d-dimer levels were measured before and after bypass. We measured postoperative blood loss and some indices of systemic inflammatory response (peak temperature, WCC and SVRI). Results: There was a significant
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