Skip to main content
SpringerLink
Log in

Adult cardiac surgery blood/blood product utilization in the post aprotinin era: an 855 patient, community hospital, retrospective experience

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background and objectives

Prior to 2008, when it was withdrawn, aprotinin use in cardiac surgery patients was associated with reduced bleeding and blood utilization, but studies linked its administration to increased patient mortality. We investigated (a) blood/blood product utilization between 2008 and 2013 at our community hospital heart center according to the type of surgery performed following the withdrawal of aprotinin and (b) clinical variables associated with increased patient blood utilization.

Materials and methods

Seven hundred nine patients were retrospectively investigated for blood/blood product utilization. Variables examined were patient age, body surface area (BSA), gender, preoperative creatinine level, hematocrit level, total cell saved blood (CSB) administered, cardiopulmonary bypass (CPB) time, type of surgical procedure performed, and preoperative clopidogrel usage. Variables (categorical and continuous) were placed into a forward stepwise regression model for the continuous outcome, packed red blood cell (PRBC) utilization. The stepwise function utilized a P value threshold of 0.25 for entering the model and 0.1 for leaving the model.

Results

For coronary artery bypass graft (CABG) surgery, use of PRBC was 29.26 % (0.75/1.44), of platelets was 14.18 % (0.24/0.72), of fresh frozen plasma (FFP) was 7.34 % (0.19/0.78), and of cryoprecipitate was 10.63 % (0.23/0.97) among our patient sample. [Data expressed as percent patient utilization, mean/S.D. in units transfused]. Increased age, smaller BSA, higher preoperative creatinine level, lower preoperative hematocrit level, longer CPB time, and increased CSB administration was associated with increased PRBC administration (P < 0.0001).

Conclusion

At our community heart surgery center, with a multidisciplinary blood conservation program in place, expected increase in blood/blood product utilization following aprotinin withdrawal was not experienced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, Hessel II EA, Hessel EA, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg. 2007;83:S27–86.

    Article  Google Scholar 

  2. Fergusson DA, Hébert PC, Mazer CD, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358:2319–31.

    Article  CAS  PubMed  Google Scholar 

  3. Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg. 2002;74:1180–6.

    Article  PubMed  Google Scholar 

  4. Horvath KA, Acker MA, Chang H, et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg. 2013;95:2194–201.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Levi M, Cromheecke ME, de Jonge E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet. 1999;354:1940–7.

    Article  CAS  PubMed  Google Scholar 

  6. Mangano DT, Tudor IC, Dietzel C. Multicenter Study of Perioperative Ischemia Research Group, Ischemia Research and Education Foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006;354:353–65.

    Article  CAS  PubMed  Google Scholar 

  7. Bennett-Guerrero E, Zhao Y, O'Brien SM, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA. 2010;304:1568–75.

    Article  CAS  PubMed  Google Scholar 

  8. Rubens FD, Boodhwani M, Mesana T, Wozny D, Wells G, Nathan HJ, et al. The cardiotomy trial: a randomized, double-blind study to assess the effect of processing of shed blood during cardiopulmonary bypass on transfusion and neurocognitive function. Circulation. 2007;116:I89–97.

    Article  PubMed  Google Scholar 

  9. Sharma AD, Al-Achi A, Seccombe JF, Hummel R, Preston M, Behrend D. Does incorporation of thromboelastography improve bleeding prediction following adult cardiac surgery? Blood Coagul Fibrinolysis. 2014;25:561–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Dixon B, Santamaria JD, Reid D, et al. The association of blood transfusion with mortality after cardiac surgery: cause or confounding? (CME). Transfusion. 2013;53:19–27.

    Article  PubMed  Google Scholar 

  11. Hogervorst E, Rosseel P, van der Bom J, et al. Tolerance of intraoperative hemoglobin decrease during cardiac surgery. Transfusion. 2014;54:2696–704. doi:10.1111/trf.12654.

    Article  CAS  PubMed  Google Scholar 

  12. DeSantis SM, Toole JM, Kratz JM, et al. Early postoperative outcomes and blood product utilization in adult cardiac surgery: the post- aprotinin era. Circulation. 2011;124:S62–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wang X, Zheng Z, Ao H, et al. Effects of aprotinin on short-term and long-term outcomes after coronary artery bypass grafting surgery. Ann Thorac Surg. 2010;89:1489–95.

    Article  PubMed  Google Scholar 

  14. Ranuccia M, European Association of Cardiothoracic Anaesthesiologists (EACTA). Perioperative haemostasis and coagulation management in cardiac surgery: a European survey. Eur J Anaesthesiol. 2007;24:1–13. doi:10.1017/S0265021507000579.

    Google Scholar 

  15. McMullan V, Alston RP. The effect of the suspension of the license for aprotinin on the care of patients undergoing cardiac surgery: a survey of cardiac anesthesiologists’ and surgeons’ opinions in the United Kingdom. J Cardiothorac Vasc Anesth. 2010;24:418–21.

    Article  PubMed  Google Scholar 

  16. Spiess BD. Pro: the practice of cardiac anesthesia has changed after the withdrawal of aprotinin. J Cardiothorac Vasc Anesth. 2010;24:875–8. doi:10.1053/j.jvca.2010.07.009.

    Article  PubMed  Google Scholar 

  17. Brevig J, McDonald J, Zelinka ES, Gallagher T, Jin R, Grunkemeier GL. Blood transfusion reduction in cardiac surgery: multidisciplinary approach at a community hospital. Ann Thorac Surg. 2009;87:532–9.

    Article  PubMed  Google Scholar 

  18. Xydas S, Magovern CJ, Slater JP, et al. Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program. J Thorac Cardiovasc Surg. 2012;143:926–35.

    Article  PubMed  Google Scholar 

  19. Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg. 1999;88:312–9.

    CAS  PubMed  Google Scholar 

  20. Sharma AD, Behrend D, Seccombe JF, et al. Can a multidisciplinary cardiac surgery blood conservation program succeed? A single center, 6 year, 687 patient retrospective blood/blood product utilization review. J Thromb Haemost. 2014;12:80.

    Google Scholar 

  21. Robich MP, Koch CG, Johnston DR, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion. 2014. doi:10.1111/trf.12903.

    PubMed  Google Scholar 

  22. Wilson CT, Fisher ES, Welch HG, Siewers AE, Lucas FL. U.S. trends in CABG Hospital volume: the effect of adding cardiac surgery programs. Health Aff. 2007;26:162–8.

    Article  Google Scholar 

  23. HHS. National blood collection and utilization survey, Department of Health and Human Services. The 2011 National Blood Collection and Utilization Survey Report. Washington, DC: HHS; 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac Anesthesia/Cardiac Surgery, St. Vincent Hospital Heart Center, 835 South Van Buren Street, Green Bay, WI, 54307-3508, USA

    Ajeet Dutt Sharma, Dana Behrend & John Forrest Seccombe

  2. Pharmaceutical Sciences, Campbell University, Buies Creek, NC, USA

    Antoine Al-Achi

Authors
  1. Ajeet Dutt Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antoine Al-Achi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dana Behrend
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Forrest Seccombe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ajeet Dutt Sharma.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants and or animals

The study was approved by St. Vincent Hospital ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this retrospective study, informed consent was not required.

Ethics approval

All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, A.D., Al-Achi, A., Behrend, D. et al. Adult cardiac surgery blood/blood product utilization in the post aprotinin era: an 855 patient, community hospital, retrospective experience. Indian J Thorac Cardiovasc Surg 32, 87–96 (2016). https://doi.org/10.1007/s12055-015-0413-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-015-0413-2

Keywords

Search

Navigation