Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding

Gregory A. Nuttall, William C. Oliver, Mark H. Ereth, Paula J. Santrach, Sandra C. Bryant, Thomas A. Orszulak, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

Background: Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. Methods: In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg · kg-1 · h-1 infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). Results: There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [ranged]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0- 3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. Conclusions: The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.

Original languageEnglish (US)
Pages (from-to)674-682
Number of pages9
JournalAnesthesiology
Volume92
Issue number3
StatePublished - Mar 2000

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Bloodless Medical and Surgical Procedures
Tranexamic Acid
Thoracic Surgery
Aprotinin
Hemorrhage
Cardiopulmonary Bypass
Intensive Care Units
Therapeutics
Placebos
Autologous Blood Transfusions
Erythrocyte Transfusion
Operating Rooms
Group Psychotherapy
Blood Volume
Blood Transfusion
Anemia
Costs and Cost Analysis

Keywords

  • Aprotinin
  • Cardiopulmonary bypass
  • Combined therapy
  • Cost
  • Intraoperative autologous blood
  • Tranexamic acid
  • Transfusion

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Nuttall, G. A., Oliver, W. C., Ereth, M. H., Santrach, P. J., Bryant, S. C., Orszulak, T. A., & Schaff, H. V. (2000). Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding. Anesthesiology, 92(3), 674-682.

Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding. / Nuttall, Gregory A.; Oliver, William C.; Ereth, Mark H.; Santrach, Paula J.; Bryant, Sandra C.; Orszulak, Thomas A.; Schaff, Hartzell V.

In: Anesthesiology, Vol. 92, No. 3, 03.2000, p. 674-682.

Research output: Contribution to journalArticle

Nuttall, GA, Oliver, WC, Ereth, MH, Santrach, PJ, Bryant, SC, Orszulak, TA & Schaff, HV 2000, 'Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding', Anesthesiology, vol. 92, no. 3, pp. 674-682.
Nuttall GA, Oliver WC, Ereth MH, Santrach PJ, Bryant SC, Orszulak TA et al. Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding. Anesthesiology. 2000 Mar;92(3):674-682.
Nuttall, Gregory A. ; Oliver, William C. ; Ereth, Mark H. ; Santrach, Paula J. ; Bryant, Sandra C. ; Orszulak, Thomas A. ; Schaff, Hartzell V. / Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding. In: Anesthesiology. 2000 ; Vol. 92, No. 3. pp. 674-682.
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N2 - Background: Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. Methods: In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg · kg-1 · h-1 infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). Results: There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [ranged]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0- 3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. Conclusions: The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.

AB - Background: Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. Methods: In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg · kg-1 · h-1 infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). Results: There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [ranged]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0- 3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. Conclusions: The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.

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