[To what extent does Trasylol decrease the need for blood and blood derivatives in postoperative acetylsalicylic acid (ASA)-induced hemorrhage in CABG surgery?]

Abstract

ASA is commonly used for many years as pain relief drug, anti-inflammatory and against temperature, as well as antiaggregatory agent in coronary disease therapy. Aprotinin (Trasylol) has antifibrinolytic properties, among other actions, inhibits intrinsic coagulation cascade, and it has been demonstrated to reduce blood loss. Can be given in different doses and by different protocols. It is frequently used in cardiosurgery to reduce postoperative bleeding in the cases when ASA is not stopped at the right time before surgery. We evaluated the effects of therapeutic ASA doses on postoperative bleeding in patients undergoing coronary bypass grafting (CABG) compared with usage of Trasylol in CABG, bleeding and blood and fresh frozen plasma (FFP) requirements. This is a retrospective study, period October 1998-March 2002. Out of total CABG patients 75 fulfilled criteria (elective surgery, first CABG)--they were divided into following groups: ASA group of 25 patients (ASA withdrawn 1-3 days before surgery), Non ASA group of 25 patients (ASA withdrawn 10 or more days before surgery) and Trasylol group of 25 patients (ASA till surgery plus Trasylol intraoperatively). Average bleeding in ASA group 24 hours postoperatively was 1600 ml, Non ASA group had average bleeding 900 ml, while Trasylol group had average drainage of 700 ml after 24 hours. ASA average blood requirement was 1800 ml, 250 ml FFP and 250 ml 5% albumin, Non ASA group has less need for blood and FFP--250 ml blood, 50 ml FFP and 30 ml 5% albumin. Our Trasylol group had quite profound bleeding and high requirements for blood and FFP--average 850 ml blood, 200 ml FFP and 150 ml 5% albumin. We recommend discontinuation of ASA therapy sufficiently early for all elective CABG, because in our case Trasylol did not give satisfactory decrease in postoperative bleeding and blood and FFP requirements. That all increase possibility of postoperative complication occurrence and increase CABG costs.