The effect of “high dose” aprotinin and other factors on bleeding and revisions for bleeding in adult coronary and valve operations: an analysis of 2190 patients during a five-year period (1987–1991)

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Abstract
We retrospectively evaluated risk factors for postoperative bleeding andfor revisions due to bleeding in 2190 adult coronary and valve patients whounderwent surgery at our hospital during the 5-year period from 1987 to1991. During this period 889 (40.6%) patients were given "high dose"aprotinin. Their mean age was 59.3 +/- 8.8 years, 1636 (74.7%) were males,200 (9.1%) underwent surgery on an emergency basis and 72 patients (3.3%)underwent redo-operations. The patients were divided into four groupsaccording to the type of surgery: all patients pooled together (2190),coronary artery surgery patients (1384, 63.2%, group I), valve surgerypatients (706, 32.2%, group II) and combined (coronary plus valve) surgerypatients (100, 4.6%, group III). Stepwise logistic regression analysis,performed to assess the risk factors for revisions due to bleeding showedaprotinin treatment to be the sole protective factor in all patients, groupI and group II. In group III only the use of a hollow fiber membraneoxygenator proved a protective factor. Risk factors for revisions forbleeding were found to be aortic cross-clamp time in all patients, group Iand group II. Use of the internal thoracic artery (ITA) was significant ingroup I patients and age at operation in group II. Multiple stepwise linearregression analysis, performed to evaluate the effect of various riskfactors on cumulative postoperative blood loss in all patients, confirmedaprotinin as the only factor capable of reducing blood loss, while aorticcross-clamp time, coronary surgery and male gender showed a positive linearrelation with postoperative bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

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