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Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion.

AbstractUNLABELLED:
Aprotinin reduces blood loss in many orthopedic procedures. In posterior lumbar spine fusion, blood loss results primarily from large vein bleeding and also occurs after the wound is closed. Seventy-two patients undergoing posterior lumbar spine fusion were randomly assigned to large-dose aprotinin therapy or placebo. All patients donated three units of packed red blood cells (RBCs) preoperatively. Postoperative blood loss was harvested from the surgical wound in patients undergoing two- and/or three-level fusion for reinfusion. The target hematocrit for RBC transfusion was 26% if tolerated. Total (intraoperative and 24 h postoperative) blood loss, transfusion requirements, and percentage of transfused patients per treatment group were significantly smaller in the aprotinin group than in the placebo group (1935 +/- 873 vs 2809 +/- 973 mL per patient [P = 0.007]; 42 vs 95 packed RBCs per group [P = 0.001]; 40% vs 81% per group [P = 0.02]). Hematological assessments showed an identically significant (a) intraoperative increase in both thrombin-antithrombin III complexes (TAT) and in activated factor XII (XIIa) and (b) decrease in activated factor VII (VIIa), indicating a similar significant effect on coagulation in patients of both groups (P = 0.9 for intergroup comparisons of postoperative VIIa, XIIa, and TAT). Intraoperative activation of fibrinolysis was significantly less pronounced in the aprotinin group than in the placebo group (P < 0.0001 for intergroup comparison of postoperative D-dimer levels). No adverse drug effects (circulatory disturbances, deep venous thrombosis, alteration of serum creatinine) were detected. Although administered intraoperatively, aprotinin treatment dramatically reduced intraoperative and 24-h postoperative blood loss and autologous transfusion requirements but did not change homologous transfusion in posterior lumbar spine fusion.
IMPLICATIONS:
In our study, aprotinin therapy significantly decreased autologous, but not homologous, transfusion requirements in posterior lumbar spine fusion.
AuthorsC Lentschener, P Cottin, H Bouaziz, F J Mercier, M Wolf, Y Aljabi, C Boyer-Neumann, D Benhamou
JournalAnesthesia and analgesia (Anesth Analg) Vol. 89 Issue 3 Pg. 590-7 (Sep 1999) ISSN: 0003-2999 [Print] United States
PMID10475286 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Hemostatics
  • Prothrombin
  • Aprotinin
  • Factor VIIa
  • Factor XIIa
Topics
  • Adult
  • Aprotinin (adverse effects, therapeutic use)
  • Blood Loss, Surgical (prevention & control)
  • Blood Transfusion
  • Double-Blind Method
  • Factor VIIa (analysis)
  • Factor XIIa (analysis)
  • Female
  • Hematocrit
  • Hemostatics (adverse effects, therapeutic use)
  • Humans
  • Intraoperative Period
  • Male
  • Middle Aged
  • Platelet Count (drug effects)
  • Postoperative Period
  • Prospective Studies
  • Prothrombin (analysis)
  • Spinal Fusion

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