Yet another meta-analysis of the data comparing aprotinin versus the lysine analogues in cardiac surgery. This one slices the 30,000 patients from good trials into subgroups of analysis according to risk of surgery—from low risk to high risk, i.e. redo sternotomy, multiple valve surgery, emergency surgery, etc. High risk is the smallest (less than 5,000 patients), and the only subgroup where the early mortality was not significantly greater in the aprotinin-treated group. It is surprising that the EMA has recommended that the suspension of aprotinin in the EU be lifted for all “appropriately managed patients undergoing isolated heart bypass surgery”.

Beverley J. Hunt