Aprotinin versus ε-aminocaproic acid for aortic surgery using deep hypothermic circulatory arrest

Objective: To compare the relative efficacy of aprotinin end E-aminocaproic acid (EACA) in decreasing blood loss and transfusion requirements after aortic surgery involving deep hypothermic circulatory arrest (DHCA). Design: A retrospective chart review. Setting: A university medical center. Participants: Forty-nine patients who had undergone thoracic aortic surgery with the use of circulatory arrest. Interventions Charts were examined for variables believed to influence postoperative blood loss, including the use of medications, and for the amount of postoperative chest tube drainage and perioperative transfusion. Measurements and Main Results: Median chest tube output (CTO) at 6 and 12 hours postoperatively was nearly identical in patients treated with aprotinin or EACA (660 and 1,015 v 700 and 950 mt for aprotinin and EACA at 6 and 12 hours, respectively), as were total perioperative blood transfusions. Complications were not significantly different between groups with the exception of a trend toward increased incidence of renal failure in the group receiving EACA. Conclusion:Aprotinin and EACA appear to be equally efficacious in reducing perioperative blood loss and transfusion requirements in patients undergoing aortic surgery involving DHCA. Questions of safety remain about the use of EACA in this setting that could not be addressed by this small retrospective study. A prospective, placebo-controlled study is warranted to confirm the absolute efficacy of these agents and to better define safety issues. Copyright (C) 1998 by W.B. Saunders Company.