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lüll Aprotinin increases mortality as compared with tranexamic acid in cardiac surgery: a meta-analysis of randomized head-to-head trials Takagi H; Manabe H; Kawai N; Goto SN; Umemoto TInteract Cardiovasc Thorac Surg 2009[Jul]; 9 (1): 98-101To determine whether aprotinin increases mortality as compared with tranexamic acid in cardiac surgery, we performed a meta-analysis of randomized head-to-head trials. All prospective randomized head-to-head trials of aprotinin vs. tranexamic acid enrolling patients undergoing cardiac surgery were identified using a web-based search engine (PubMed). For each study, data regarding mortality in both the aprotinin and tranexamic acid groups were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic RRs in random-effects models. Our search identified nine trials (eight trials included in the previous meta-analysis and the blood conservation using antifibrinolytics in a randomized trial [BART] study). Seven trials were composed of low-risk patients (n=1291) and two trials consisted of low-risk patients (n=1628). Pooled analysis of the nine trials demonstrated a statistically significant 45% increase in mortality with aprotinin relative to tranexamic acid therapy (RR, 1.45; 95% CI, 1.00 [1.0002]-2.11; P=0.05 [0.0499]). The present meta-analysis of updated all randomized head-to-head trials, the best evidence, demonstrated a statistically significant increase in mortality with aprotinin relative to tranexamic acid therapy in cardiac surgery.|Antifibrinolytic Agents/*adverse effects[MESH]|Aprotinin/*adverse effects[MESH]|Blood Loss, Surgical/mortality/*prevention & control[MESH]|Blood Transfusion[MESH]|Cardiac Surgical Procedures/adverse effects/*mortality[MESH]|Consumer Product Safety[MESH]|Evidence-Based Medicine[MESH]|Humans[MESH]|Odds Ratio[MESH]|Randomized Controlled Trials as Topic[MESH]|Risk Assessment[MESH]|Tranexamic Acid/*adverse effects[MESH]|Treatment Outcome[MESH] |