Document Detail


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:  2014-09-18    
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.
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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/HL/NHLBI NIH HHS; R01 HL057952-02/HL/NHLBI NIH HHS; R01 HL057952-12/HL/NHLBI NIH HHS; R01 HL059165/HL/NHLBI NIH HHS; R01 HL059165-02/HL/NHLBI NIH HHS; R01 HL059165-12/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; 6T84R30KC1/Tranexamic Acid; 9087-70-1/Aprotinin; EC 3.4.21.21/Factor VIIa
Comments/Corrections

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