Abstract Objective: To test the hypothesis that use of aprotinin at half dose would be more cost-effective or as efficacious as full-dose aprotinin or no aprotinin during open heart surgery. Design: Cost-effective analysis, unmasked prospective comparison. Setting: Community hospital. Patients: One hundred thirty-three patients undergoing open heart surgery. Interventions: Patients in 3 consecutive groups undergoing open heart surgery were allocated to receive no aprotinin, full-dose aprotinin, or half-dose aprotinin. Main Outcome Measures: Total cost (in dollars) of blood products administered plus cost of aprotinin at various dosages, comparison of total blood products administered during hospitalization, and closure time required in the operating room. Results: Full-dose and half-dose aprotinin significantly (P<.05) reduced the total blood products administered during hospitalization and the operating room closure time. However, use of half-dose aprotinin resulted in a significant cost savings (P<.05) when compared with either the cost of blood products required in the nodose aprotinin group or the cost of blood products plus aprotinin in the full-dose aprotinin group. Conclusion: Use of aprotinin at half dose in a community hospital resulted in a significant reduction in costs, blood product use, and operating room closure time in patients undergoing open heart surgery.Arch Surg. 1997;132:858-861 References 1. Bidstrup BP, Royston DM, Sapsford RN, Taylor KM. Reduction in blood loss and blood use after cardiopulmonary bypass with high-dose aprotinin (Trasylol) . J Thorac Cardiovasc Surg . 1989;97:364-372. 2. Cosgrove DM, Heric B, Lytle BW, et al. Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study . Ann Thorac Surg . 1992; 54:1031-1038.Crossref 3. Lemmer JH Jr, Stanford W, Bonney SL, et al. Aprotinin for coronary bypass operations: efficacy, safety, and influence on early saphenous vein graft patency . J Thorac Cardiovasc Surg . 1994;107:543-553. 4. Davis R, Whittington R. Aprotinin: a review of its pharmacology and therapeutic efficacy in reducing blood loss associated with cardiac surgery . Drugs . 1995; 49:954-983.Crossref 5. Schönberger JPAM, Everts PAM, Ercan H, et al. Low-dose aprotinin in internal mammary artery bypass operations contributes to important blood saving . Ann Thorac Surg . 1992;54:1172-1176.Crossref 6. Liu B, Tengborn L, Larson G, et al. Half-dose aprotinin preserves hemostatic function in patients undergoing bypass operations . Ann Thorac Surg . 1995;59:1534-1540.Crossref 7. Levy JH, Pifarre R, Schaff HV, et al. A multicenter double-blind, placebocontrolled trial of aprotinin for reducing blood loss and the requirement for donorblood transfusion in patients undergoing repeat coronary artery bypass grafting . Circulation . 1995;92:2236-2244.Crossref 8. Lemmer JH, Dilling EW, Morton JR, et al. Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens . Ann Thorac Surg . 1996;62:1659-1668.Crossref 9. Harder MP, Eijsman L, Roozendaal KJ, van Oeveren W, Wildevuur CRH. Aprotinin reduces intraoperative and postoperative blood loss in membrane oxygenator cardiopulmonary bypass . Ann Thorac Surg . 1991;51:936-941.Crossref 10. Bidstrup BP, Underwood SR, Sapsford RN, Streets EM. Effect of aprotinin (Trasylol) on aorto-coronary bypass graft patency . J Thorac Cardiovasc Surg . 1993; 55:147-153. 11. Wendel HP, Heller W, Michel J, Mayer G, Ochsenfahrt C, Graeter U. Lower cardiac troponin T levels in patients undergoing cardiopulmonary bypass and receiving high-dose aprotinin therapy indicate reduction of perioperative myocardial damage . J Thorac Cardiovasc Surg . 1995;108:1164-1172.Crossref 12. Levy JH, Ramsay JG, Murkin J. Aprotinin reduces the incidence of strokes following cardiac surgery . Circulation . 1996;94( (suppl) ):l-535.
Archives of Surgery – American Medical Association
Published: Aug 1, 1997
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