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.
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