Elektronisk udgave - Sundhedsstyrelsen

have to be treated with aprotinin so that one would avoid allogeneic
transfusion (NNT 4.7 (4.0-6.1)).
◆ The relative effect of aprotinin appeared similar in cardiac and other types
of surgery.
◆ There seemed to be some relationship between dose and response (greatest
effect, when aprotinin given in high dose).
◆ Blood savings: 37 trials reported the number of units blood transfused.
Overall, aprotinin resulted in a saving of 1.23 units (0.92-1.55).
◆ Transfusion protocol: There seemed little difference between the effect of
aprotinin in trials that employed a transfusion protocol and those who
did not.
◆ Complications: Importantly, use of aprotinin reduced the need for reoperation,
and there was a trend towards lower overall mortality in
aprotinin-treated patients.
Desmopressin
ISPOT-results (cardiac surgery)
There were 12 studies of desmopressin for cardiac surgery (69, 70,
97-106) involving a total of 793 patients, of whom 386 were randomized
to active treatment. All trials but one were placebo-controlled.
The largest study enrolled a total of 99 patients, and the median
size was 65 patients. Most studies used a dose of 0.3 µg/kg intravenously
at the end of cardiopulmonary bypass.
❖ In contrast to the other drugs reviewed in the ISPOT-study, desmopressin
had no statistically significant effect upon the proportion
of patients receiving transfusion (OR 0.98 (0.64-1.50)).
However, in subgroup analyses, the efficacy of desmopressin appeared
to vary depending upon the use of aspirin.
❖ In studies in which no patients received aspirin, the likelihood
of allogeneic transfusion (OR) was 0.75 (0.29-1.97); compared
with a likelihood of OR 1.26 (0.81-1.94) if some patients received
aspirin, and a likelihood of OR 0.21 (0.07-0.62) if all
patients were taking aspirin.
❖ Complications: In the six trials that reported re-operations for
bleeding, 2.0% of patients receiving desmopressin underwent
surgery compared with 2.8% in the control groups (OR 0.87
(0.23-3.27)). The frequency of perioperative myocardial infarction
was 4.4% in patients treated with desmopressin and
1.6% in patients in the control group (OR 1.85 (0.74-4.62)).
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