Overview Blood transfusion risks and outcome Hemostasis Available

Overview Blood transfusion; risks and outcome Hemostasis Available agent -Lysine analogue -Aprotinin -r. FVIIa Conclusion

Public Demand-Canada “If you needed surgery, would you accept a blood transfusion? ” 44% said “No” 89% preferred an alternative Feb, 1996, Canadian Public Survey Attitude About Blood and Blood Alternatives; Gallop Poll

Full-dose aprotinin use in CABG : an analysis of phamacotherapy and perioperative patients outcomes • Full dose aprotinin use was associated with a lower risk of adverse cardiovascular outcomes and a reduced need for use of vasoactive drugs • The risk of death and perioperative MI was not affected by aprotinin therapy Royston D et al. Anesth Analg 2006 Nov; 103(5): 1082 -8

Conclusion(1) • Associations between transfusion and worse outcomes. • Transfusion of aged blood does not increase tissue O 2. • Immunomodulation is real. • Blood conservation techniques need to be developed.

Conclusion(2) • Lysine analogs have variable effects on reducing bleeding • Aprotinin is a broad spectrum protease inhibitor that reduces bleeding and the need for allogeneic transfusions • The increasing use of platelet inhibitors, specifically clopidogrel, increases the risk of bleeding. • r. FVIIa is a novel, off label approach for refractory surgical bleeding.

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