BACKGROUND: Patients with ischemic heart disease are frequently maintained on a regimen of aspirin because of its ability to reduce variable thrombotic complications. However, aspirin has been recognized as a causative factor of increased perioperative bleeding. This study was aimed to determine whether aprotinin maintain its efficacy at reducing blood loss in patients on aspirin undergoing off-pump coronary artery bypass grafting (OPCAB).

METHODS: In the prospective, double blind, randomized study, we investigated 30 patients on preoperative aspirin medication undergoing OPCAB surgery. Patients received aprotinin (1 x 106 KIU bolus for loading plus 0.5 x 106 KIU/hr, n = 15, the aprotinin group) or saline solution (n = 15, the control group). Operation time, total transfusion amount during operation, and plasma D-dimer levels immediately after the induction of anesthesia and immediately after operation were investigated and compared between and within groups where possible.

RESULTS: Both group showed no comparable demographic and operation data such as operation time and number of grafts. The aprotinin group showed significantly less transfusion amount than the control group (packed RBC 352.7 ± 89.2 ml vs 478.0 ± 132.1 ml). Compared with that immediately after anesthetic induction value, postoperative D-dimer significantly increased in the control group but not in the aprotinin group.

CONCLUSIONS: The above results suggest that aprotinin significantly reduces transfusion amount and probably inhibits fibrinolysis in patients with aspirin undergoing OPCAB.