Tranexamic acid versus Aprotinin: Effects on postoperative blood loss and transfusion requirements in patients undergoing elective primary coronary artery bypass grafting

Introduction: Due to excessive fibrinolysis during cardiac surgery accomplished by abnormal bleeding, several authors recommend prophylactic use of antifibrinolytic agents. Since August 2005 we changed our regimen of antifibrinolytic therapy from aprotinin (AP) to tranexamic acid (TXA). We evaluated the effects of TXA with AP on perioperative blood loss and allogenic transfusion requirements on patients undergoing elective primary CABG retrospectively.

Methods: Demographics and clinical data of patients undergoing CABG between August and December 2004 were compared with those between August and December 2005. The AP group received 2.0 million KIU AP. The TXA group received 100mg/kg body weight. The postoperative blood loss and allogenic transfusion requirements were evaluated within the first 24 hours. The other clinical data including intubation time, ICU stay, hospital stay and mortality were recorded.

Result: The data of 227 patients (AP: n=115, TXA: n=112) were analysed. The postoperative blood loss in AP group (741±411ml) was not significantly different from TXA group (782±507ml, p=0.25). AP group received 1.0±2.0 units of red blood cells (TXA 2.0±2.0, p=0.09), 0.4±1.2 units of fresh frozen plasma (TXA 1.0±2.7, p=0.16). There were no significant difference between the two groups with regards to intubation time, ICU stay, hospital stay and mortality.

Conclusion: Clinically, aprotinin and Tranexamic acid have similar effects on postoperative blood loss and the need for transfusion in patients undergoing elective primary CABG. Since tranexamic acid is by far cheaper than aprotinin, it can be preferably used in this set of patients