| Differential effects of aprotinin and tranexamic acid on outcomes and cytokine profiles in neonates undergoing cardiac surgery. | |
| | |
MedLine Citation:
|
PMID: 22075061 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
Eric M Graham; Andrew M Atz; Jenna Gillis; Stacia M Desantis; A Lauren Haney; Rachael L Deardorff; Walter E Uber; Scott T Reeves; Francis X McGowan; Scott M Bradley; Francis G Spinale |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. Date: 2011-11-09 |
Journal Detail:
|
Title: The Journal of thoracic and cardiovascular surgery Volume: 143 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2012 May |
Date Detail:
|
Created Date: 2012-04-16 Completed Date: 2012-06-04 Revised Date: 2013-05-23 |
Medline Journal Info:
|
Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 1069-76 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
|
Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. grahamem@musc.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Age Factors Analysis of Variance Antifibrinolytic Agents / adverse effects, economics, therapeutic use* Aprotinin / administration & dosage, economics, therapeutic use* Blood Loss, Surgical / mortality, prevention & control* Cardiac Surgical Procedures* / adverse effects, mortality Chi-Square Distribution Cytokines / blood* Erythrocyte Transfusion Factor VIIa / therapeutic use Female Heart Defects, Congenital / economics, mortality, surgery* Hospital Charges Humans Infant, Newborn Inflammation Mediators / blood* Interleukin-2 / blood Male Platelet Transfusion Postoperative Hemorrhage / blood, economics, etiology, mortality, prevention & control* Recombinant Proteins / therapeutic use Respiration, Artificial Retrospective Studies Risk Assessment Risk Factors South Carolina Time Factors Tranexamic Acid / adverse effects, economics, therapeutic use* Treatment Outcome Tumor Necrosis Factor-alpha / blood |
| Grant Support | |
ID/Acronym/Agency:
|
HL057952/HL/NHLBI NIH HHS; HL059165/HL/NHLBI NIH HHS; R01 HL057952-02/HL/NHLBI NIH HHS; R01 HL059165-02/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Antifibrinolytic Agents; 0/Cytokines; 0/IL2 protein, human; 0/Inflammation Mediators; 0/Interleukin-2; 0/Recombinant Proteins; 0/Tumor Necrosis Factor-alpha; 0/recombinant FVIIa; 1197-18-8/Tranexamic Acid; 9087-70-1/Aprotinin; EC 3.4.21.21/Factor VIIa |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective.
Next Document: Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip.