In this before-after multicenter study the authors tested the hypothesis that the prophylactic use of aprotinin compared to tranexamic acid could reduce the proportion of patients presenting severe perioperative bleeding.

Perioperative bleeding remains a real challenge for physicians managing cardiac surgical patients. In patients at high risk for excessive bleeding the prophylactic use of antifibrinolytics may be useful. This study propose to compare the efficacity and innocuity of aprotinin and tranexamic acid to reduce the proportion of patient presenting severe peri-operative bleeding according the Universal Definition of Perioperative Bleeding (UDPB) classification.

Inclusion Criteria:

patients undergoing cardiac on pump surgery at high risk for bleeding defined by :

• Aorto-coronary bypasses surgery (2 or more) under dual platelet aggregation therapy (Primary or redo)
• Heart transplant (Primary or Redo)
• Infectious endocarditis (Primary or Redo)
• Ascending acute aortic dissection (Primary or Redo)
• Artificial heart / LVAD under CEC (Primary or Redo)
• Combined surgery, Redo
• Ascending aorta surgery, Redo

Exclusion Criteria:

• Off pump cardiac surgery
• Patient not meeting the inclusion criteria
• Patient not receiving antifibrinolytic therapy
• Patient with absolute contraindication to antifibrinolytics,
• Patient refusing to give access to their medical chart,
• Patient not meeting the inclusion criteria
• Patient protected by the law, under guardianship or trusteeship,
• Patient deprived of liberty

consecutive patients undergoing cardiac surgery with a high risk of hemorrhage who have received a prophylactic infusion of either tranexamic acid or aprotinin and meeting the protocol criteria between july 2017 and october 2020 in seven university hospital centers.