Vonk Alexander B A, Meesters Michael I, Schats Joep, Romijn Johannes W A, Jansen Evert K, Boer Christa
Department of Cardio-Thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Interact Cardiovasc Thorac Surg. 2011 Feb;12(2):135-9. doi: 10.1510/icvts.2010.250936. Epub 2010 Nov 12.
This retrospective study investigated whether withdrawal of aprotinin from combined low-dose aprotinin/tranexamic acid (TXA) antifibrinolytic therapy altered postoperative blood loss and transfusion requirements in patients undergoing cardiothoracic surgery employing cardiopulmonary bypass (CPB). The study included data from patients receiving a combination of low-dose aprotinin (2×10(6) KIU in CPB prime; n=615) and 2000 mg TXA or patients receiving TXA only (n=587). In both groups, TXA was given after protamine administration. Study endpoints were blood loss, transfusion requirements and reoperation. There were no differences in EuroSCORE, CPB time, antiangial medication and baseline coagulation parameters between groups. There were more males in the TXA group (85%) as compared to the TXA+aprotinin group (77%; P=0.02). Postoperative blood loss (0.80±0.69 vs. 0.66±0.52 l; P=0.001) and transfusion of fresh frozen plasma (0.6±0.7 vs. 0.4±0.6 U; P<0.001), packed cells (3.9±5.5 vs. 2.7±3.3 U; P<0.001) and platelets (0.7±0.6 vs. 0.5±0.6 U; P<0.001) was higher in the TXA group than in patients receiving combined therapy, respectively. There were more reoperations for bleeding in the TXA group (53 vs. 34, respectively; P=0.03) with similar mortality and deterioration in glomerular filtration rate. In conclusion, withdrawal of aprotinin from combined antifibrinolytic therapy is associated with increased blood loss, transfusion requirements and reoperations.
这项回顾性研究调查了在接受体外循环（CPB）的心胸外科手术患者中，从低剂量抑肽酶/氨甲环酸（TXA）联合抗纤溶治疗中停用抑肽酶是否会改变术后失血量和输血需求。该研究纳入了接受低剂量抑肽酶（CPB预充液中2×10⁶KIU；n = 615）与2000 mg TXA联合治疗的患者数据，或仅接受TXA治疗的患者数据（n = 587）。在两组中，TXA均在鱼精蛋白给药后给予。研究终点为失血量、输血需求和再次手术。两组之间在欧洲心脏手术风险评估系统（EuroSCORE）、CPB时间、抗心绞痛药物使用情况和基线凝血参数方面无差异。与TXA + 抑肽酶组（77%；P = 0.02）相比，TXA组男性更多（85%）。TXA组术后失血量（0.80±0.69 vs. 0.66±0.52 l；P = 0.001）以及新鲜冰冻血浆输注量（0.6±0.7 vs. 0.4±0.6 U；P < 0.001）、红细胞悬液（3.9±5.5 vs. 2.7±3.3 U；P < 0.001）和血小板输注量（0.7±0.6 vs. 0.5±0.6 U；P < 0.001）均高于接受联合治疗的患者。TXA组因出血进行再次手术的情况更多（分别为53例和34例；P = 0.03），两组死亡率和肾小球滤过率恶化情况相似。总之，从联合抗纤溶治疗中停用抑肽酶与失血量增加、输血需求增加和再次手术有关。
