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Summary and conclusionContact of the patient’s blood and cells with the non-endothelial surface of extracorporeal circulation is responsible for several reactions due to disturbance of the haemostatic system with activation of the plasma proteolytic system.Antifibrinolytic drugs have been used either to treat or to prevent excessive bleeding associated with cardiac surgery. Aprotinin (serine protease inhibitor), a natural antifibrinolytic prevent plasmin degradation, and inhibit thrombin generation. Tranexamic acid, a synthetic antifibrinolytic, binds to lysine binding site of plasminogen and prevents binding to fibrin hence fibrinolysis.The effect of these drugs on blood loss, homologous blood transfusion, coagulation pattern in patient undergoing cardiac surgery with extracorporeal circulation was investigated in this study considering the cost-efficacy relationship.In the present study, 60 patients were studied, divided into 3 groups; 20 patients received tranexamic acid, 20 patients received low dose regimen of aprotinin and 20 patients received high dose regimen of aprotinin.To study the effect of these drugs, we measured the blood loss intraoperatively, 6 hours later and 24 hours later, the amount of transfused blood or blood product haematological parameters including haemoglobin, haematocrit, platelet count, PT, PTT, bleeding time and Fibrinogen Degradation Products (FDPs) and Activated Clotting Time (ACT).This study demonstrated that the use of aprotinin in both doses reduced blood loss more than tranexamic acid, but there was no significant changes in the blood and blood product requirements. The level of FDPs was significantly lower in patients receiving aprotinin than those receiving tranexamic acid indicating better antifibrinolytic activity. However, tranexamic acid is much cheaper and with no significant increase of blood requirement than aprotinin.In conclusion, although aprotinin decreased the amount of blood loss and FDP’s level postoperatively but tranexamic acid is much cheaper and blood requirements do not differ between the patients of the three groups. So, from the cost-efficacy point of view, tranexamic acid is better than aprotinin.
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