Casati V, Guzzon D, Oppizzi M, Bellotti F, Franco A, Gerli C, Cossolini M, Torri G, Calori G, Benussi S, Alfieri O
Department of Anesthesiology, University of Milano, Division of Cardiac Anesthesia and Intensive Care, Epidemiology Unit, and Division of Cardiac Surgery, San Raffaele Hospital, Milano, Italy.
J Thorac Cardiovasc Surg. 2000 Sep;120(3):520-7. doi: 10.1067/mtc.2000.108016.
Since excessive fibrinolysis during cardiac surgery is frequently associated with abnormal perioperative bleeding, many authors have advocated prophylactic use of antifibrinolytic drugs to prevent hemorrhagic disorders. We compared the effects of tranexamic acid (a synthetic antifibrinolytic drug) with aprotinin (a natural derivative product with antifibrinolytic properties) on perioperative bleeding and the need for allogeneic transfusions.
In a single-center prospective randomized unblinded trial, 1040 consecutive patients undergoing primary, elective cardiac operations with cardiopulmonary bypass received either high-dose aprotinin or tranexamic acid. The aprotinin group (518 patients) received 280 mg in 20 minutes before the skin incision, 280 mg in the priming solution of the extracorporeal circuit, and a continuous infusion of 70 mg/h throughout the operation. The tranexamic acid group (522 patients) received 1 g in 20 minutes before the skin incision, 500 mg in the priming solution of the extracorporeal circuit, and a continuous infusion of 400 mg/h during the operation. Postoperative bleeding, perioperative transfusions, and hematologic variables were evaluated at fixed times. Postoperative thrombotic complications, intubation time, intensive care unit stay, and hospital stay were recorded.
Postoperative bleeding was similar in the 2 groups: aprotinin 250 mL (150-400 mL) versus tranexamic acid 300 mL (200-450 mL) (median and 25th-75th quartiles), median difference of 50 mL (95% confidence intervals, 0-50 mL). The number of transfusions and the outcome did not differ.
Tranexamic acid and aprotinin show similar clinical effects on bleeding and allogeneic transfusion in patients undergoing primary elective heart operations. Since tranexamic acid is about 100 times cheaper than aprotinin, its use is preferable in this type of patient.
由于心脏手术期间过度纤溶常与围手术期异常出血相关，许多作者主张预防性使用抗纤溶药物以预防出血性疾病。我们比较了氨甲环酸（一种合成抗纤溶药物）与抑肽酶（一种具有抗纤溶特性的天然衍生产品）对围手术期出血及异体输血需求的影响。
在一项单中心前瞻性随机非盲试验中，1040例连续接受初次择期心脏手术并使用体外循环的患者，分别接受高剂量抑肽酶或氨甲环酸治疗。抑肽酶组（518例患者）在皮肤切口前20分钟给予280mg，体外循环预充液中给予280mg，并在整个手术过程中持续输注70mg/h。氨甲环酸组（522例患者）在皮肤切口前20分钟给予1g，体外循环预充液中给予500mg，并在手术期间持续输注400mg/h。在固定时间评估术后出血、围手术期输血及血液学变量。记录术后血栓形成并发症、插管时间、重症监护病房停留时间及住院时间。
两组术后出血量相似：抑肽酶组为250mL（150 - 400mL），氨甲环酸组为300mL（200 - 450mL）（中位数及第25 - 75四分位数），中位数差异为50mL（95％置信区间，0 - 50mL）。输血次数及结果无差异。
氨甲环酸和抑肽酶对接受初次择期心脏手术患者的出血及异体输血显示出相似的临床效果。由于氨甲环酸比抑肽酶便宜约100倍，在这类患者中使用更为可取。
Zotero 插件