J Korean Orthop Assoc.  2007 Jun;42(3):318-323. 10.4055/jkoa.2007.42.3.318.

Aprotinin Reduced Blood Loss in Spinal Deformity Surgery

• Suk SI
• Kim JH
• Kim SS
• Kim JH
• Cho BC
• Jung NY

• KMID: 2186555
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.318

Abstract

PURPOSE: Complications are quite common in surgery to correct spinal deformities due to the long duration under anesthesia and massive blood loss. The aim of this study was to evaluate and compare the effectiveness of Aprotinin in spinal deformity surgery.
MATERIALS AND METHODS
Fifty-nine patients who underwent spinal deformity surgery were analyzed. Thirty-two patients were administered Aprotinin, and 27 control patients were not. The Pre- and Post- operative hemoglobin and hematocrit, blood loss, transfusion requirements, operative time, postoperative blood loss through suction drains and duration of suction drains were measured in both groups.
RESULTS
There were no differences in age, gender, height, weight, hemodynamic indices, postoperative blood loss through the suction drains and the duration of the suction drains between the two groups. Intraoperative blood loss, transfusion and operative time were 1,345+/-425 cc, 1,008+/-721 cc, and 247 minutes in the Aprotinin (+) group and 2,070+/-1,276 cc, 2,552+/-2,791 cc, and 279 minutes in the Aprotinin (-) group, respectively. The postoperative hemoglobin and hematocrit levels were also significantly different (12.9+/-1 cc and 38.3+/-3.1% in the Aprotinin (+) group, and 11.9+/-1.8 cc and 35+/-5.5% in the Aprotinin (-) group, respectively).
CONCLUSION
There was significantly less intraoperative blood loss, transfusion and surgery time in the group administered Aprotinin. Therefore, Aprotinin can be used in spinal deformity surgery that has a high risk of massive blood loss.

Keyword

Spinal deformity surgery; Blood loss; Aprotinin

MeSH Terms

Anesthesia
Aprotinin*
Congenital Abnormalities*
Hematocrit
Hemodynamics
Humans
Operative Time
Postoperative Hemorrhage
Suction
Aprotinin

Reference

1. Beierlein W, Scheule AM, Dietrich W, Ziemer G. Forty years of clinical aprotinin use: a review of 124 hypersensitivity reactions. Ann Thorac Surg. 2005. 79:741–748.

2. Bitan FD. Aprotinin in spine surgery: review of the literature. Orthopedics. 2004. 27:Suppl 6. S681–S683.

3. Dewachter P, Mouton C, Masson C, Gueant JL, Haberer JP. Anaphylactic reaction to aprotinin during cardiac surgery. Anaesthesia. 1993. 48:1110–1111.

4. Diefenbach C, Abel M, Limpers B, et al. Fatal anaphylactic shock after aprotinin reexposure in cardiac surgery. Anesth Analg. 1995. 80:830–831.

5. Dietrich W. Incidence of hypersensitivity reactions. Ann Thorac Surg. 1998. 65:Suppl 6. S60–S74.

6. Janssens M, Joris J, David JL, Lemaire R, Lamy M. High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology. 1994. 80:23–29.

7. Khoshhal K, Mukhtar I, Clark P, Jarvis J, Letts M, Splinter W. Efficacy of aprotinin in reducing blood loss in spinal fusion for idiopathic scoliosis. J Pediatr Orthop. 2003. 23:661–664.

8. Kokoszka A, Kuflik P, Bitan F, Casden A, Neuwirth M. Evidence-based review of the role of aprotinin in blood conservation during orthopaedic surgery. J Bone Joint Surg Am. 2005. 87:1129–1136.

9. Langdown AJ, Field J, Grote J, Himayat H. Aprotinin (trasylol) does not reduce bleeding in primary total hip arthroplasry. J Arthroplasty. 2000. 15:1009–1012.

10. Lemmer JH Jr, Stanford W, Bonney SL, et al. Aprotinin for coronary artery bypass grafting: effect on postoperative renal function. Ann Thorac Surg. 1995. 59:132–136.

11. Lentschener C, Cottin P, Bouaziz H, et al. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion. Anesth Analg. 1999. 89:590–597.

12. Molenaar Q, Begliomini B, Grazi GL, Ringers J, Terpstra OT, Porte RJ. The effect of aprotinin on renal function in orthotopic liver transplantation. Transplantation. 2001. 71:247–252.

13. Morin NJ, Frau A, Nonclercq D, et al. Potentiation of gentamicin nephrotoxicity in the rat by infusion of aprotinin. Exp Mol Pathol. 1994. 60:197–213.

14. Samama CM, Langeron O, Rosencher N, et al. Aprotinin versus placebo in major orthopedic surgery: a randomized, double-blinded, dose-ranging study. Anesth Analg. 2002. 95:287–293.

15. Shiga T, Wajima Z, Inoue T, Sakamoto A. Aprotinin in major orthpedic surgery: a systematic review of randomized controlled trials. Anesth Analg. 2005. 101:1602–1607.

16. Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O. The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine. 2001. 26:1152–1156.