• John P Scott, Daniel J Costigan, George M Hoffman, Pippa M Simpson, Mahua Dasgupta, Rowena Punzalan, Richard J Berens, James S Tweddell, and Eckehard A E Stuth.
• Department of Anesthesiology, Medical College of Wisconsin, Milwaukee WI 53201-3022, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53201-3022, USA; Children's Hospital of Wisconsin, Milwaukee WI 53201-1997, USA. Electronic address: scottjake@mcw.edu.
• J Clin Anesth. 2014 May 1;26(3):204-11.

Study ObjectiveTo evaluate whether conversion from aprotinin to epsilon-aminocaproic acid (EACA) during infant cardiac surgery was associated with increased perioperative bleeding.DesignStructured retrospective chart review.SettingUniversity-affiliated large congenital cardiac surgery program.MeasurementsRecords from 145 infants (age < 1 yr) receiving aprotinin as antifibrinolytic therapy for cardiac surgery between 6/1/2006 and 12/31/2006 were compared with a cohort of infants receiving EACA for cardiac surgery between 6/1/2008 and 12/31/2008. Sixty-eight infants received aprotinin and 77 infants received EACA. Measured indicators of perioperative bleeding included transfusion volumes, recombinant activated clotting factor VIIa (rFVIIa) administration, need for reexploration, and perioperative chest tube output.Main ResultsEACA treated patients received significantly more rFVIIa for uncontrolled bleeding (19/77 [25%] vs 3/68 [4%]; P < 0.001) and required surgical reexploration more frequently (21/77 [27%] vs 7/68 [10%]; P = 0.01]. Median (25th-75th percentiles) intraoperative platelet transfusion requirements were also increased after the switch to EACA (28 mL [0-58 mL] vs 0 mL [0 mL - 34.5 mL]), but this difference did not reach statistical significance (P = 0.06).ConclusionsBleeding in infant cardiac surgery increased following the change in antifibrinolytic therapy from aprotinin to EACA. Given the potential for major harm, especially thrombotic complications, from rFVIIa use, prospective studies examining the safety of postcardiopulmonary bypass rFVIIa administration in infants are necessary before the routine off-label use may be recommended.Copyright © 2014 Elsevier Inc. All rights reserved.

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