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Increased recombinant activated factor VII use and need for surgical reexploration following a switch from aprotinin to epsilon-aminocaproic acid in infant cardiac surgery. J Clin Anesth 2014 May;26(3):204-11 PMID: 24809789

Pubmed ID

24809789

Abstract

STUDY OBJECTIVE: To evaluate whether conversion from aprotinin to epsilon-aminocaproic acid (EACA) during infant cardiac surgery was associated with increased perioperative bleeding.

DESIGN: Structured retrospective chart review.

SETTING: University-affiliated large congenital cardiac surgery program.

MEASUREMENTS: Records from 145 infants (age < 1 yr) receiving aprotinin as antifibrinolytic therapy for cardiac surgery between 6/1/2006 and 12/31/2006 were compared with a cohort of infants receiving EACA for cardiac surgery between 6/1/2008 and 12/31/2008. Sixty-eight infants received aprotinin and 77 infants received EACA. Measured indicators of perioperative bleeding included transfusion volumes, recombinant activated clotting factor VIIa (rFVIIa) administration, need for reexploration, and perioperative chest tube output.

MAIN RESULTS: EACA treated patients received significantly more rFVIIa for uncontrolled bleeding (19/77 [25%] vs 3/68 [4%]; P < 0.001) and required surgical reexploration more frequently (21/77 [27%] vs 7/68 [10%]; P = 0.01]. Median (25th-75th percentiles) intraoperative platelet transfusion requirements were also increased after the switch to EACA (28 mL [0-58 mL] vs 0 mL [0 mL - 34.5 mL]), but this difference did not reach statistical significance (P = 0.06).

CONCLUSIONS: Bleeding in infant cardiac surgery increased following the change in antifibrinolytic therapy from aprotinin to EACA. Given the potential for major harm, especially thrombotic complications, from rFVIIa use, prospective studies examining the safety of postcardiopulmonary bypass rFVIIa administration in infants are necessary before the routine off-label use may be recommended.

Author List

Scott JP, Costigan DJ, Hoffman GM, Simpson PM, Dasgupta M, Punzalan R, Berens RJ, Tweddell JS, Stuth EA

Authors

George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
John P. Scott MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin

Scopus

2-s2.0-84901652434   10 Citations

MESH terms used to index this publication - Major topics in bold

Aminocaproic Acid
Antifibrinolytic Agents
Aprotinin
Blood Loss, Surgical
Blood Transfusion
Cardiac Surgical Procedures
Factor VIIa
Hemostatics
Humans
Infant
Infant, Newborn
Platelet Transfusion
Recombinant Proteins
Retrospective Studies