Fibrinolysis-adjusted perioperative low-dose aprotinin reduces blood loss in bypass operations Martin Misfeld, MD, Sven Dubbert, Sawas Eleftheriadis,

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Fibrinolysis-adjusted perioperative low-dose aprotinin reduces blood loss in bypass operations Martin Misfeld, MD, Sven Dubbert, Sawas Eleftheriadis, MD, Hans-Joachim Siemens, MD, Thomas Wagner, PhD, Hans-Hinrich Sievers, MD The Annals of Thoracic Surgery Volume 66, Issue 3, Pages 792-799 (September 1998) DOI: 10.1016/S0003-4975(98)00646-8

Fig 1 Course of prothrombin F1+2 level. Prothrombin F1+2 levels showed no significant differences among groups. group C = control; group A = aprotinin group; group TA = tranexamic acid group. (NS = not significant versus control.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 2 Course of the concentration of thrombin–antithrombin III complexes. At 2 and 24 hours after protaminazation, levels of these complexes are significantly reduced in the tranexamic acid group (TA group) (TA) and aprotinin group (group A) compared with controls (group C). (NS = not significant versus control; ∗p < 0.01; ∗∗p < 0.001; °p < 0.05.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 3 Course of plasminogen level. Preoperatively and at 24 hours postoperatively the plasminogen level was significant higher in the aprotinin group (group A) versus the control group (group C). (group TA = tranexamic acid group; NS = not significant versus control; ∗p < 0.01 versus control.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 4 Course of α2-antiplasmin level. The α2-antiplasmin values are in normal range preoperatively with significant differences between the tranexamic acid group (group TA) versus the control group (group C) and group TA versus the aprotinin group (group A). There was a decrease of α2-antiplasmin in all groups intraoperatively followed by an increase in group TA and group C up to 24 hours postoperatively. After an initially mild increase at 2 hours, group A showed a decrease up to 24 hours postoperatively. (NS = not significant versus control; ∗p < 0.01; ∗∗p < 0.001; ∗∗∗p < 0.0001; °°p < 0.005 [versus control].) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 5 Course of plasmin-α2–antiplasmin complex level. There is an intraoperative increase in the aprotinin group (group A) and the tranexamic acid group (group TA) followed by a decrease in the postoperative course. In group TA the increase in plasmin-α2–antiplasmin complex lasted until 6 hours postoperatively, followed by a decrease at 24 hours. (group C = control group; NS = not significant versus control; °p < 0.05; ∗∗p < 0.001.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 6 Course of levels of d-dimers. At all times postoperatively levels of d-dimers were significantly decreased in the tranexamic acid group (group TA) and the aprotinin group (group A) compared with control (group C) (∗∗p < 0.001; ∗∗∗p < 0.0001; °°°p < 0.0005.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 7 Course of factor VIIa level. The factor VIIa level showed a significant decrease in the aprotinin group (group A) versus the control group (group C) and the tranexamic acid group (group TA) intraoperatively. (NS = not significant versus control; °p < 0.05.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)

Fig 8 Postoperative blood loss. In the tranexamic acid group (group TA) and the aprotinin group (group A), postoperative blood loss was significantly reduced versus controls (group C) at all times up to 24 hours. At 24 hours postoperatively blood loss was also significantly reduced in group TA versus group A. (∗∗p < 0.001; ∗∗∗p < 0.0001; °p < 0.05; °°p < 0.005; °°°p < 0.0005.) The Annals of Thoracic Surgery 1998 66, 792-799DOI: (10.1016/S0003-4975(98)00646-8)