Tranexamic Acid as Replacement Antifibrinolytic for Aprotinin – An Efficacy and Safety Study

Abstract

Purpose Aprotinin was the primary anti-fibrinolytic agent used in high risk cardiac surgical procedures including cardiac transplantation, however, was known to increase the risk of death, cardiac, neurologic and renal complications. At the University of Pittsburgh Medical Center (UPMC), Tranexamic Acid (TA)was substituted for Aprotinin. The primary goal of this study is to determine whether the replacement antifibrinolyrtic, TA is associated with less post-operative bleeding and complications compared to Aprotinin. Methods and Materials We have reviewed the medical records of patients who underwent orthoptic heart transplantation from June 2006 to December 2010. The following data were collected: (1) pre-operative data: age, gender, ASA status, medications, laboratory test results, coagulopathy and past medical history; (2) intra-operative data: cardiopulmonary bypass time, aortic cross clamp time, warm ischemic time, use of red blood cells on pump, post bypass blood and product transfusion, (3) post-operative data: chest tube drainage in the first 24 hours post-operatively, blood products transfusion requirement, surgical re-explorations, short-term patient survival and cardiac, neurological and renal morbidity. The data is analyzed by Stata 12/IC software. Results A total of 159 patient’s data were reviewed. Sixty eight patients received aprotinin and the rest (n=91) received TA. Groups were smiliar with regards to age, sex and preoperative medications. Chest tube bleeding in the first 24 hours was 1692 + 1958 cc compared to TA group (1433 + 1440 cc). P-value 0.439. Aprotinin group received 2.98 + 4.85 units of red cells compared to 1.79 + 3.18 red cells in TA group (P=0.133). No significant difference in red cell, fresh frozen plasma and platelet transfusion was identified in both the groups.No difference in the incidence of renal, neurologic and 30 day mortality was found between the two groups. Conclusions In conclusion, TA is as effective as Aprotinin and safe to use as antifibrinolytic in patients undergoing heart transplantation.