Changing from aprotinin to tranexamic acid results in increased use of blood products and recombinant factor viia for aortic surgery requiring hypothermic arrest.
Since the withdrawal of aprotinin from the market in 2007 and the replacement by lysine analogs, there are divergent opinions about increased bleeding tendencies after major cardiac surgery. In this retrospective analysis of 160 patients undergoing aortic surgery under deep hypothermic circulatory arrest, Sniecinski et al. demonstrated increased transfusion requirements with tranexamic acic (TXA) in comparison to aprotinin. Interestingly, the rate of seizures was significantly higher with TXA (0% vs. 6.4%) corroborating the rumors in the literature about a linkage between seizure rate and TXA. Given the limitations of a retrospective analysis, this study shows the need for more potent antifibrinolytic drugs for complex cardiac surgery.
– Wulf Dietrich