The Effect of the Suspension of the License for Aprotinin on the Care of Patients Undergoing Cardiac Surgery: A Survey of Cardiac Anesthesiologists' and Surgeons' Opinions in the United Kingdom

ObjectiveThe primary aim was to poll the opinions of cardiac anesthesiologists and surgeons as to the effect of the suspension of the license for aprotinin on patients undergoing cardiac surgery.DesignA mailed questionnaire.SettingUnited Kingdom.ParticipantsMembers of the Association of Cardiothoracic Anaesthetists and the Society for Cardiothoracic Surgery in Great Britain and Ireland with a UK address.InterventionsA structured questionnaire.Measurements and Main ResultsOf the 546 dispatched surveys, 285 (52%) were returned. While the majority of respondents (61%) felt it had not had any effect, 29% of respondents felt the suspension of the license for aprotinin had had a detrimental effect on patient care and 2% an extremely detrimental effect. Eight percent of respondents reported a beneficial effect. Since license suspension, the reported use of aprotinin had declined and tranexamic acid use had risen. The majority of respondents reported no change in the use of packed red cells (66%), blood products (53%), mechanical cell salvage (84%), factor VIIa (79%), or frequency of reopening for bleeding (65%). Respectively, 32%, 45%, 24%, and 20% of respondents reported a perceived increased use of these products, and 30% reported an increased frequency of reopening for bleeding. Apart from knowledge regarding local aprotinin stock, there was no significant difference in opinions between surgeons and anesthesiologists.ConclusionsWhile the majority of respondents felt that the suspension of the license for aprotinin had no effect, almost a third felt it had impacted negatively on the care of patients undergoing cardiac surgery.