Cost-benefit and efficacy of aprotinin compared with ε-aminocaproic acid in patients having repeated cardiac operations: A randomized, blinded clinical trial

Elliott Bennett-Guerrero, Jonathan G. Sorohan, Miguel L. Gurevich, Paul E. Kazanjian, Roberto R. Levy, Alberto V. Barberá, William D. White, Thomas F. Slaughter, Robert N. Sladen, Peter K. Smith, Mark F. Newman

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

Background: Aprotinin and ε-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery. The marked difference in average wholesale cost between these two drug therapies (aprotinin, $1,080 vs. ε- aminocaproic acid, $11) has generated significant controversy regarding their reactive efficacies and costs. Methods: In a multicenter, randomized, prospective, blinded trial, patients having repeated cardiac surgery received either a high-dose regimen of aprotinin (total dose, 6 x 106 kallikrein inactivator units) or ε-aminocaproic acid (total dose, 270 mg/kg). Results: Two hundred four patients were studied. Overall (data are median [25th-75th percentiles]), aprotinin-treated patients had less postoperative thoracic drainage (511 ml [383-805 ml] vs. 655 ml [464-1,045 ml]; P = 0.016) and received fewer platelet transfusions (0 [range, 0-1] vs. 1 [range, 0-2]; P = 0.036). The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients (44% vs. 26%, P = 0.012). No differences, however, were seen in allogeneic erythrocyte transfusions or in the time required for chest closure. Overall, direct and indirect bleeding-related costs were greater in aprotinin- than in ε-aminocaproic acid-treated patients ($1,813 [$1,476-2,605] vs. $1,088 [range, $511-2,057]; P = 0.0001). This difference in cost per case varied in magnitude among sites but not in direction. Conclusions: Aprotinin was more effective than ε-aminocaproic acid at decreasing bleeding and platelet transfusions, ε-aminocaproic acid, however, was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery. A cost-benefit analysis using the lower cost of half-dose aprotinin ($540) still resulted in a significant cost advantage using ε-aminocaproic therapy (P = 0.022).

Original languageEnglish
Pages (from-to)1373-1380
Number of pages8
JournalAnesthesiology
Volume87
Issue number6
DOIs
StatePublished - Dec 1997

Keywords

  • Aprotinin
  • Coagulation
  • Complications: bleeding
  • Cost-benefit analysis
  • Fibrinolysis
  • Surgery: cardiac
  • ε-aminocaproic acid

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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