Major transfusions remain frequent despite the generalized use of tranexamic acid: an audit of 3322 patients undergoing cardiac surgery

BACKGROUND Aprotinin has been reapproved for use in Europe and in Canada. We sought to determine if its reintroduction was still pertinent given the widespread administration of tranexamic acid, another antifibrinolytic shown to reduce bleeding and transfusions. STUDY DESIGN AND METHODS After instit...

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Published in:Transfusion (Philadelphia, Pa.) Pa.), 2016-07, Vol.56 (7), p.1857-1865
Main Authors: Stevens, Louis-Mathieu, Noiseux, Nicolas, Prieto, Ignacio, Hardy, Jean-François
Format: Article
Language:English
Subjects:
Acids
Antifibrinolytic Agents - therapeutic use
Aprotinin - therapeutic use
Blood Transfusion - utilization
Cardiac Surgical Procedures - adverse effects
Cardiac Surgical Procedures - methods
Cardiac Surgical Procedures - mortality
Databases, Factual
Heart surgery
Hemorrhage - etiology
Hemorrhage - mortality
Hemorrhage - therapy
Humans
Mortality
Perioperative Care - methods
Postoperative Hemorrhage - prevention & control
Propensity Score
Retrospective Studies
Risk Factors
Tranexamic Acid - therapeutic use
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Summary:BACKGROUND Aprotinin has been reapproved for use in Europe and in Canada. We sought to determine if its reintroduction was still pertinent given the widespread administration of tranexamic acid, another antifibrinolytic shown to reduce bleeding and transfusions. STUDY DESIGN AND METHODS After institutional review board approval, we examined the cardiac surgery database (2012‐2015; 3322 patients). Major transfusion was defined as 4 or more red blood cell units. A stratified multivariate logistic regression analysis identified predictors of major transfusion; 1064 patients were matched by propensity score to compare outcomes of patients with or without major transfusion. RESULTS Cardiopulmonary bypass (CPB) was used in 2342 patients; 98.9% received tranexamic acid versus 15.2% (149/980) in off‐pump coronary artery bypass graft patients. Major transfusion was required in 758 patients (23%). Age, low body mass index, low preoperative hemoglobin or platelet count, recent use of P2Y12 receptor blockers, chronic kidney disease, NYHA functional class, left ventricular ejection fraction of less than 30%, prior cardiac surgery, urgency, type of cardiac surgery, and duration of CPB were all independent predictors of major transfusions (all p 
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.13615