DRUGS TO MINIMIZE PERIOPERATIVE BLOOD-LOSS IN CARDIAC-SURGERY - METAANALYSES USING PERIOPERATIVE BLOOD-TRANSFUSION AS THE OUTCOME

Citation
A. Laupacis et D. Fergusson, DRUGS TO MINIMIZE PERIOPERATIVE BLOOD-LOSS IN CARDIAC-SURGERY - METAANALYSES USING PERIOPERATIVE BLOOD-TRANSFUSION AS THE OUTCOME, Anesthesia and analgesia, 85(6), 1997, pp. 1258-1267
Citations number
86
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
Journal title
ISSN journal
0003-2999
Volume
85
Issue
6
Year of publication
1997
Pages
1258 - 1267
Database
ISI
SICI code
0003-2999(1997)85:6<1258:DTMPBI>2.0.ZU;2-P
Abstract
Concern about the side effects of allogeneic red blood cell transfusio n has increased interest in methods of minimizing perioperative transf usion. We performed meta-analyses of randomized trials evaluating the efficacy and safety of aprotinin, desmopressin, tranexamic acid, and e psilon-aminocaproic acid in cardiac surgery. All identified randomized trials in cardiac surgery were included in the meta-analyses. The pri mary outcome was the proportion of patients who received at least one perioperative allogeneic red cell transfusion. Sixty studies were incl uded in the meta-analyses. The largest number of patients (5808) was a vailable for the meta-analysis of aprotinin, which significantly decre ased exposure to allogeneic blood (odds ratio [OR] 0.31, 95% confidenc e interval [CI] 0.25-0.39; P < 0.0001). The efficacy of aprotinin was not significantly different regardless of the type of surgery (primary or reoperation), aspirin use, or reported transfusion threshold. The use of aprotinin was associated with a significant decrease in the nee d for reoperation because of bleeding (OR 0.44, 95% CI 0.27-0.73; P = 0.001). Desmopressin was not effective, with an OR of 0.98 (95% CI 0.6 4-1.50; P = 0.92). Tranexamic acid significantly decreased the proport ion of patients transfused (OR 0.50, 95% CI 0.34-0.76; P = 0.0009). ep silon-Aminocaproic acid did not have a statistically significant effec t on the proportion of patients transfused (OR 0.20, 95% CI 0.04-1.12; P = 0.07). There were not enough patients to exclude a small but clin ically important increase in myocardial infarction or other side effec ts for any of the medications. We conclude that aprotinin and tranexam ic acid, but not desmopressin, decrease the number of patients exposed to perioperative allogeneic transfusions in association with cardiac surgery. Implications: Aprotinin, desmopressin, tranexamic acid, and e psilon-aminocaprole acid are used in cardiac surgery in an attempt to decrease the proportion of patients requiring blood transfusion. This meta-analysis of all published randomized trials provides a good estim ate of the efficacy of these medications and is useful in guiding clin ical practice. We conclude that aprotinin and tranexamic acid, but not desmopressin, decrease the exposure of patients to allogeneic blood t ransfusion perioperatively in relationship to cardiac surgery.