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Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations.

Publication ,  Journal Article
Miller, BE; Tosone, SR; Tam, VK; Kanter, KR; Guzzetta, NA; Bailey, JM; Levy, JH
Published in: Ann Thorac Surg
August 1998

BACKGROUND: Aprotinin consistently reduces blood loss and transfusion requirements in adults during and after cardiac surgical procedures, but its effectiveness in children is debated. We evaluated the hemostatic and economic effects of aprotinin in children undergoing reoperative cardiac procedures with cardiopulmonary bypass. METHODS: Control, low-dose aprotinin, and high-dose aprotinin groups were established with 15 children per group. Platelet counts, fibrinogen levels, and thromboelastographic values at baseline and after protamine sulfate administration, number of blood product transfusions, and 6-hour and 24-hour chest tube drainage were used to evaluate the effects of aprotinin on postbypass coagulopathies. Time needed for skin closure after protamine administration and lengths of stay in the intensive care unit and the hospital were recorded prospectively to determine the economic impact of aprotinin. RESULTS: Coagulation tests performed after protamine administration rarely demonstrated fibrinolysis but did show significant decreases in platelet and fibrinogen levels and function. The thromboelastographic variables indicated a preservation of platelet function by aprotinin. Decreased blood product transfusions, shortened skin closure times, and shortened durations of intensive care unit and hospital stays were found in the aprotinin groups, most significantly in the high-dose group with a subsequent average reduction of nearly $3,000 in patient charges. CONCLUSIONS: In children undergoing reoperative cardiac surgical procedures, aprotinin is effective in attenuating postbypass coagulopathies, decreasing blood product exposure, improving clinical outcome, and reducing patient charges.

Duke Scholars

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

August 1998

Volume

66

Issue

2

Start / End Page

535 / 540

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Thrombelastography
  • Respiratory System
  • Reoperation
  • Prospective Studies
  • Platelet Count
  • Length of Stay
  • Humans
  • Hemostatics
  • Fibrinogen
 

Citation

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ICMJE
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Miller, B. E., Tosone, S. R., Tam, V. K., Kanter, K. R., Guzzetta, N. A., Bailey, J. M., & Levy, J. H. (1998). Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations. Ann Thorac Surg, 66(2), 535–540. https://doi.org/10.1016/s0003-4975(98)00469-x
Miller, B. E., S. R. Tosone, V. K. Tam, K. R. Kanter, N. A. Guzzetta, J. M. Bailey, and J. H. Levy. “Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations.Ann Thorac Surg 66, no. 2 (August 1998): 535–40. https://doi.org/10.1016/s0003-4975(98)00469-x.
Miller BE, Tosone SR, Tam VK, Kanter KR, Guzzetta NA, Bailey JM, et al. Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations. Ann Thorac Surg. 1998 Aug;66(2):535–40.
Miller, B. E., et al. “Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations.Ann Thorac Surg, vol. 66, no. 2, Aug. 1998, pp. 535–40. Pubmed, doi:10.1016/s0003-4975(98)00469-x.
Miller BE, Tosone SR, Tam VK, Kanter KR, Guzzetta NA, Bailey JM, Levy JH. Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations. Ann Thorac Surg. 1998 Aug;66(2):535–540.
Journal cover image

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

August 1998

Volume

66

Issue

2

Start / End Page

535 / 540

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Thrombelastography
  • Respiratory System
  • Reoperation
  • Prospective Studies
  • Platelet Count
  • Length of Stay
  • Humans
  • Hemostatics
  • Fibrinogen