Cost effectiveness of routine antifibrinolytic therapy in cardiac surgery: Tranexamic acid shows equivalent effects and reduces costs compared to aprotinin

Objectives: Routine use of antifibrinolytic drugs is an accepted therapeutic option to reduce postoperative blood loss and resource utilization. The cost explosion of aprotinin forced us to evaluate a less expensive alternative, tranexamic acid, TA, (Cyklokapron®). Aim of this study was to find out if the less expensive alternative antifibrinolytic drug shows equivalent effects concerning chest tube drainage and need for blood products. Methods: After positive voting of the local ethic committee, we randomized 404 patients scheduled for CABG, AVR or combined AVR + CABG procedures in either tranexamic (TA, n=200) or aprotinin (A, n=204) group. Patient data were analyzed with regard to chest tube drainage, need for blood products and reexploration quote. Costs for antifibrinolytic therapy and blood products were evaluated simultaneously. Results: see table parameters aprotinin tranexam p chest tube drainage (48h): median [ml] 918 790 <0.05 reexploration rate (overall 3.3%) 3.0% 3.8% n.s. red blood cell package (EK): Sum costs (à 75 €) [n] 55.425 [739] 43.575 [581] <0.05 fresh frozen plasma (FFP): Sum costs (à 67 €) [n] 48.977 [731] 26.130 [390] <0.05 thrombocyte package (TK): Sum costs (à 467 €) [n] 30.822 [ 66] 27.553 [ 59] n.s. Sum costs blood products (€) [per pat.] 135.224 [662] 97.258 [486] <0.05 Sum costs antifibrinolytic drugs (€) [per pat.] 40.800 [200] 2.600 [ 13] <0.05 Sum overall costs (€) [per pat.] 176.024 [862] 99.858 [499] <0.05 Conclusions: Compared to aprotinin, tranexamic acid shows equivalent effects. The analysis of resource utilization shows clear economic benefits for tranexamic acid. Consequently, it became the new standard antifibrinolytic drug in our institution.