Author/Authors :
Ghavidel, AA Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Jalilifar, N Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Sharifi, M. Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Ghasemzadeh, B. Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Alinejad, Z. Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Ghafarinejad, MH. Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Khamushi, A Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Bakhshande, H Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Hosseini, S. Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Farsad, F Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران , Yousefnia, MA Shahid Rajaei Cardiovascular, Medical and Research Center - Cardiac Surgery Department, تهران, ايران
Abstract :
Background: Post-operative bleeding is one of the Challenging issues in cardiacsurgery. The Excessive bleeding and need for transfusion of blood products may increases the patients’ mortality and morbidity. Although use of antifibrinolytics has long been the issue of interest but recently according to some reports of sudden death after use of aprotinin has encountered great limitations. So we decided to find an alternative drug for aprotinin. Methods and Materials: This study was performed as a Double blind Randomized clinical traial. Three hundred patients underwent open heart surgery using CPB to Shahid Rajaee Heart Center. The patients were divided into 3 groups; each containing 100 patients. Group A Amicar (Caproamin) , group B (Tranexamic acid) and group C (Control). The mean age was 56.5 yr. (Ranged 16-79). 65.3% were male and 85.7% underwent CABG. Need for blood and blood products transfusion in operating room, ICU ward, as well ad post-op drainage volume during 6, 12, 24 hours were evaluated. The probable post-op complications including post-op myocardial infarction or CNS, renal complications were also recorded. Results: The average volume of hemorrhage in group A was 427 cc, 558 cc in group B 659 cc, in group C, but these differences were not significant statistically (P=0.55). In group A 46% of patients need 1-8 unit of blood, in group B this rate was 60% and in group C was 69% (P=0.093). Prevalence of post op MI was zero in group A 2% in group B and 3% in group C (P=0.377). Incidence of Re- explorationwas 4% in group A, 5% in group B 6% in group C (P=0.810). The length of hospital stay was the least in group A and was the most in group B, but this difference was also not as significant (P=0.964) Comment: Antifibrinolytics, particularly Caproamin can play a role in decreasing post operative mediastinal bleeding, especially non surgical bleeding. Both Transamin and Caproamin are safe and do not increase thromboembolic events and other complications. These drugs do not cause significant reduction in volume of postoperative bleeding and transfusion requirements in OR and ICU, but when just CABG cases are considered, Caproamin causes significant reduction in post op hemorrhage and as a result reduction in transfusion requirements of blood products.
