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use because the risk of reaction appears to be highest during this time
(205, 206). Although the results from the available trials are conflicting,
there is enough evidence to suggest that aprotinin may cause reversible
postoperative renal dysfunction in some patients who undergo
routine cardiac surgery. There is no way of predicting which
patients will be affected.
In the ISPOT-meta-analysis, there was a nonsignifcant trend towards
an increase of myocardial infarction in cardiac sugery patients
treated with aprotinin. In some randomized trials, the frequency
of myocardial infarction and graft thrombosis was increased
in patients receiving aprotinin, whereas in others it was not.
(Given that the efficacy of aprotinin is well established, it is unlikely
that trials will ever be done that enroll sufficient numbers of
patients to determine whether aprotinin causes a small but clinically
important increase in the risk of myocardial infarction in patients
undergoing cardiac surgery.)
Desmopressin
Side effects of desmopressin include facial flushing, headache, hypotension,
hyponatremia, water intoxication, seizures and anecdotal
reports of thrombotic events.
As for cardiac surgery, several trials have clearly documented a significant
decrease in mean arterial pressure and systematic vascular
resistance lasting up to 30 minutes after infusion of desmopressin in
a substantial portion of patients (103, 105). The hypotension is responsive
to a combination of fluids and vasopressors. Too few patients
have been studied for any definite conclusion to be made on
the safety of desmopressin in orthopedic surgery.
Given the fact that the available studies have failed to show consistantly
that desmopressin is effective in decreasing the transfusion
requirement of patients in cardiac surgery, it seems reasonably to
choose more effective alternatives (except in patients with type I
von Willebrand disease and mild hemophilia, for whom the use of
desmopressin is appropiate).
TXA
Being a synthetic antifibrinolytic, the side effects of this type of
pharmaceutical include gastrointestinal symptoms, myonecrosis
and thrombosis (cerebral, dissiminated intavascular coagulation
(DIC), cardiac and venous). However, gastro-intestinal side effects
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