Ayda TÜRKÖZ, Ahmet KÖROĞLU, Rıza TÜRKÖZ, M. Özcan ERSOY

Koroner arter cerrahisinde aprotinin ve traneksamik asit: 1) Koagülasyon sistemi, kan ve kan ürünleri transfüzyonu üzerine etkileri

Aprotinin ve traneksamik asitin (TA) kan kaybı ve kan ürünleri transfüzyonuna etkilerini primer koroner arter bypass greftlemesi olgularında prospektif ve randomize olarak değerlendirdik.Altmış olgu üç gruba ayrıldı: Aprotinin alanlar (total 6 x 106 KIU, n=20, Grup A), Traneksamik asit alanlar (total 10 g, n=20, Grup T) ve ilaç almayanlar (n=20, Grup K). Demografik ve cerrahi özellikler, rutin koagülasyon testleri, plazminojen, fibrinojen ve D-dimer düzeyleri karşılaştırıldı. Operasyon sırasında ve postopertif kan kaybı saptandı. Kan ürünleri transfüzyonu standart bir protokole göre uygulandı. Aprotinin grubunda kardiopulmoner bypass (KPB) sonrası altıncı saatte aPTT (aktive parsiyel tromboplastin zamanı) diğer gruplara göre istatistiksel olarak anlamlı artarken (p

Anahtar Kelimeler:

Kan nakli, Plazminojen, Aprotinin, Kalp cerrahi işlemleri, Hemostaz, Kan pıhtılaşma testleri, İleriye dönük çalışma, Kardiyopulmoner bypass, Traneksamik asit

Aprotinin and tranexamic acid in coronary artery bypass operations: 1) The effects on coagulation system, blood and blood products transfusion

We evaluated the effects of aprotinin and tranexamic acid (TA) on blood loss and the need for transfusion of blood products in a prospective randomized study following primary coronary artery bypass grafting, surgery.Sixty patients were allocated to three groups: aprotinin (total dose 6 x 10<sup>6</sup> KIU, n=20, Group A), TA (total 10 g, n=20 Group T), and nonmedicated controls (n=20, Group C). Demographic, surgical data, routine coagulation tests, plasminogen, fibrinogen and D-dimer levels were compared. Intraoperative and postoperative blood loss were determined. Blood products were tranfused according to a standardized protocol. Whole blood aPTT (activated partial thromboplastin time) significantly increased in Group A compared to others (p<0.005). Aprotinin and tranexamic acid both reduced the levels of D-dimer (p<0.001) 6 hours after cardiopulmonary bypass (CPB). The levels of plasminogen were significantly low in Group A than Group C 6 hours after CPB (p<0.05) and in Group T than Group C 24 hours after CPB (p<0.005). Total blood loss was significantly reduced by aprotinin (Group A 792±44 ml, Group C 1164±95 ml; p0.01) but there was no significant difference by TA (Group T 942±72 ml). The use of whole blood and blood products during and after operation were significantly less in Group A (1.65±0.39 U) compared with Group C (6.35±1.12 U; p<0.001), and the difference was insignificant in Group T (4.45±0.91 ml). In conclusion, aprotinin is more effective in the improvement of hemostasis after primary coronary artery bypass grafting compared with TA.

Keywords:

Blood Transfusion, Plasminogen, Aprotinin, Cardiac Surgical Procedures, Hemostasis, Blood Coagulation Tests, Prospective Studies, Cardiopulmonary Bypass, Tranexamic Acid,

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