Place de l'aprotinine en chirurgie cardiaque

Abstract

A recent article in a famous medical journal has questionned the safety of aprotinin utilization in cardiac surgery. As opposed to this observational study, we are reporting meta-analysis on antifibrinolytic therapy efficacy and safety.

Four meta-analysis published between 1994 and 2006 are concerned. They show the efficacy of aprotinin and tranexamic acid for decreasing the number of allogeneic blood-transfusions (PRC) and the patients receiving at least one unit of PRC. Aprotinin also decreased of incidence of reoperations for bleeding. Antifibrinolytic therapy did not influence mortality and perioperative complications such as myocardial infarction, stroke and acute renal failure. By contrast the data issued of 18 trials demonstrated a reduction of strokes with aprotinin therapy. The results of the recent observational study are discussed. Physicians therapeutic choice should be lead by randomised trials when such data exist.