Ann Thorac Surg 1998;66:799
© 1998 The Society of Thoracic Surgeons
Original articles: cardiovascular
Invited commentary
Roque Pifarré, MDa
a Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153, USA
 |
Invited commentary
|
|---|
 Top
 Invited commentary
|
|---|
This report by Misfeld and associates presents a prospective, randomized study of 42 patients undergoing primary bypass grafting who received a low dose of aprotinin or a low dose of tranexamic acid intraoperatively and postoperatively compared with a control group that received no antifibrinolytic medication. The study evaluated fibrinolysis and a new perioperative low-dose aprotinin regimen adjusted to the time course of fibrinolysis. The postoperative blood loss in the patients treated with antifibrinolytic agents was significantly less than that of the control group (p < 0.005). In the first 24 hours the blood loss was significantly lower in the aprotinin group than in the tranexamic acid group (p < 0.05).
This report suffers significantly from the very small group of patients. It is virtually impossible to obtain statistically significant data for comparative purposes when the numbers available in the three groups are 14, for a total of 42 patients. It should also be pointed out that Misfeld and associates studied a population at low risk for bleeding: primary bypass grafting, ejection fraction of 0.45 or less, no preoperative intravenous heparin infusion, and no administration of aspirin in the last 5 days before the operation.
I think this study by Misfeld and associates is an interesting one, but before we can reach any conclusions, the study should be repeated with a larger number of patients.
