Evaluation and Comparison of Use of low-Dose Aprotinin and Tranexamic Acid in CABG: A Double-Blind, Prospective, Randomized Study of 150 Patients

Background- Cardiovascular operations are associated with an inherent bleeding tendency that sometime leads to severe bleeding and transfusion requirement. Pharmacologic intervention to minimize post-bypass bleeding and blood product transfusions has received increasing attention for both medical and economic perspectives. Methods- In this double-blind, randomized, placebo-controlled clinical trial, three groups of patients, each comprising 50 patients undergoing on-pump coronary artery bypass grafting surgery (CABG) were blindly randomized to receive either low aprotinin, tranexamic acid, or placebo; the results were subsequently evaluated and compared between the groups. Results- The following variables were similar in the groups, and there were no statistically significant differences in these variables: age (p value=0.308), sex (p value=0.973), hyperlipidemia (p value=0.720), hypertension (p value=0.786), smoking (p value=0.72), and diabetes (p value=0.960). The amounts of drainage from chest tubes were less in the aprotinin and tranexamic acid groups compared to the placebo group, and this was statistically significant (p value 0.001). There was no statistically significant difference in need for reoperation for bleeding between the three groups (p value=0.998). Complications following surgery in the three groups were statistically the same and not significantly different (Table below). All the complications had a good course, and all the patients were discharged from hospital uneventfully. There was no mortality in any group. Conclusions- Low-dose aprotinin and tranexamic acid can significantly reduce blood loss and transfusion requirement in CABG without importantly increasing mortality and morbidity