Continuation of preoperative aspirine therapy does not increase blood loss in coronary bypass patients

This study was designed to evaluate efficacy and tolerability of two different doses of aprotinin in patients receiving aspirin before undergoing coronary artery bypass grafting. Forty-two patients were randomized to receive either placebo (group I), or aprotinin in doses of 4 000 000 KIU (group II) or 6 000 000 KIU (group III). Drug efficacy was determined by measuring postoperative blood loss and transfusion of blood products. Both doses were effective in reducing blood loss and transfusion requirements. Blood loss through thoracotomy drainage was 450 ± 224, 182 ± 144, 142 ± 98 ml, respectively, for control and treatment groups II and III ( p = 0.0001). The numbers of patients with blood transfusions were seven (50%), two (17%) and two (17%) for group I and treatment groups II and III, respectively ( p = 0.10). Tolerability was excellent and complications few and reversible. In conclusion, high and medium doses of aprotinin were well tolerated and reduced bleeding and transfusion requirements in patients submitted to coronary bypass surgery under the effects of aspirin.

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EPIDURAL EPINEPHRINE INFUSION COMBINED WITH BUPIVACAINE MAY INCREASE BLOOD LOSS DURING LABOR AND DELIVERY

Anesthesia & Analgesia ◽

10.1097/00000539-199902001-00260 ◽

1999 ◽

Vol 88 (Supplement) ◽

pp. 261S

Author(s):

T. Okutomi ◽

J. Mochizuki ◽

K. Amano ◽

S. Hoka

Keyword(s):

Blood Loss ◽

Labor And Delivery ◽

Epinephrine Infusion ◽

Increase Blood Loss

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Heparin Administration And Precision Protamine Reversal In Coronary Bypass Surgery

10.1055/s-0038-1653148 ◽

1981 ◽

Author(s):

Charles Markham

Keyword(s):

Blood Loss ◽

Coronary Bypass ◽

Testing Procedure ◽

Published Data ◽

Clotting Time ◽

Test Protocol ◽

Precise Control ◽

Activated Clotting Time ◽

Heparin Administration ◽

Recalcification Time

A two-tiered testing procedure was developed which uses the activated clotting time (ACT) dose-response curve for the initialization and maintenance of heparinization while using the whole blood activated recalcification time (wBART) for a more precise control of protamine neutralization. The wBART, the most sensitive test for heparin induced hypocoagulability, parallels the ACT and is prolonged by protamine excess, allowing a rapid and accurate titration procedure. This twotiered test protocol results in decreased protamine usage and less blood loss compared to published data in a comparable patient population.The protocol was applied to a study with 55 by-pass patients to compare two commercial beef lung heparins with respect to anticoagulant effectiveness, intraoperative ACT levels, total heparin usage, post-operative blood loss and protamine requirements. Platelet counts were also monitored before and following surgery. No statistically significant differences were observed between the two heparin products in any of these parameters. Details of the two-tiered protocol and the beef lung heparin study will be presented.

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