Differential effects of aprotinin and tranexamic acid on outcomes and cytokine profiles in neonates undergoing cardiac surgery.
J Thorac Cardiovasc Surg
; 143(5): 1069-76, 2012 May.
Article
em En
| MEDLINE
| ID: mdl-22075061
ABSTRACT
OBJECTIVE:
Factors contributing to postoperative complications include blood loss and a heightened inflammatory response. The objective of this study was to test the hypothesis that aprotinin would decrease perioperative blood product use, reduce biomarkers of inflammation, and result in improved clinical outcome parameters in neonates undergoing cardiac operations.METHODS:
This was a secondary retrospective analysis of a clinical trial whereby neonates undergoing cardiac surgery received either aprotinin (n = 34; before May 2008) or tranexamic acid (n = 42; after May 2008). Perioperative blood product use, clinical course, and measurements of cytokines were compared.RESULTS:
Use of perioperative red blood cells, cryoprecipitate, and platelets was reduced in neonates receiving aprotinin compared with tranexamic acid (P < .05). Recombinant activated factor VII use (2/34 [6%] vs 18/42 [43%]; P < .001), delayed sternal closure (12/34 [35%] vs 26/42 [62%]; P = .02), and inotropic requirements at 24 and 36 hours (P < .05) were also reduced in the aprotinin group. Median duration of mechanical ventilation was reduced compared with tranexamic acid 2.9 days (interquartile range 1.7-5.1 days) versus 4.2 days (2.9-5.2 days), P = .04. Production of tumor necrosis factor and interleukin-2 activation were attenuated in the aprotinin group at 24 hours postoperatively. No differential effects on renal function were seen between agents.CONCLUSIONS:
Aprotinin, compared with tranexamic acid, was associated with reduced perioperative blood product use, improved early indices of postoperative recovery, and attenuated indices of cytokine activation, without early adverse effects. These findings suggest that aprotinin may have unique effects in the context of neonatal cardiac surgery and challenge contentions that antifibrinolytics are equivalent with respect to early postoperative outcomes.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ácido Tranexâmico
/
Aprotinina
/
Perda Sanguínea Cirúrgica
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Citocinas
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Mediadores da Inflamação
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Hemorragia Pós-Operatória
/
Cardiopatias Congênitas
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Procedimentos Cirúrgicos Cardíacos
/
Antifibrinolíticos
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article