Efficacy of Aprotinin in Reducing Blood Loss in Spinal Fusion for Idiopathic Scoliosis

Khoshhal, Khalid I.; Mukhtar, Iftikhar; Clark, Peter; Jarvis, James; Letts, Merv; Splinter, William M.

doi:10.1097/00004694-200309000-00017

Cited by 17 publications

(36 citation statements)

References 16 publications

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“…Aprotinin (Trasylol Ò , Bayer), an antifibrinolytic, has proven to be very effective in reducing preoperative blood loss in major orthopaedic procedures, thereby minimizing the need for blood products [5,8,14]. Although its exact mechanism of action has not been completely understood, it modulates coagulation factors by inhibiting plasmin and kallikrein activity [11,15].…”

Section: Introductionmentioning

confidence: 99%

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Aprotinin in pediatric neuromuscular scoliosis surgery

et al. 2008

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Reduction of blood transfusions in patients with neuromuscular scoliosis can decrease potential complications such as immune suppression, infection, hemolytic reaction and viral transmission. Aprotinin (Trasylol Ò , Bayer), an antifibrinolytic, has proven to be effective in reducing blood loss in cardiac and liver surgery, but little data exists in patients undergoing spinal fusion for neuromuscular scoliosis. The purpose of this study was to evaluate the safety and efficacy of aprotinin in pediatric neuromuscular scoliosis patients undergoing spinal fusion. The medical records of all patients undergoing initial spinal fusions for neuromuscular scoliosis between January 1999 and March 2003 were reviewed to determine demographic data, perioperative data, wound drainage and number of transfusion required. Cases were compared to a matched group of historical controls. We had 14 patients in the aprotinin group and 17 in the control group. Total blood loss in the aprotinin group was significantly lower compared to the control group (715 vs. 2,110 ml; P = 0.007). Significantly less blood loss occurred in the aprotinin group when blood loss per kilogram was evaluated as well (23 vs. 60 ml/kg, respectively; P = 0.002). Intra-operative packed red blood cell (PRBC) transfusions were also significantly lower in the aprotinin group (1.25 vs. 3.16 units; P = 0.001). No clinical evidence of anaphylaxis, deep vein thrombosis (DVT) or renal failure was observed in the aprotinin group. After considering the price of drug therapy, operating room time, and the cost of blood products, the use of aprotinin saved an average of $8,577 per patient. In our series, the use of aprotinin resulted in decreased blood loss and a decreased rate of transfusions in children with neuromuscular scoliosis undergoing extensive spinal fusion. At out institution, the use of aprotinin is safe and cost effective for patients with neuromuscular scoliosis.

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Section: Introductionmentioning

confidence: 99%

“…Aprotinin has been extensively used in cardiothoracic surgery [2,13] and recently in orthopaedic surgery [4,5,8,12,14]. However, despite the expanding role of aprotinin in orthopaedic surgical cases, there is limited data evaluating the role of this antifibrinolytic in scoliosis surgery in children with neuromuscular disease.…”

Section: Introductionmentioning

confidence: 99%

Aprotinin in pediatric neuromuscular scoliosis surgery

et al. 2008

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“…[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] Of all the types of surgeries, spinal fusion and cardiac operations have been the most extensively studied (Tables II and III). For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is probably the safest and the most effective way to avoid the use of allogenic blood products.…”

mentioning

confidence: 99%

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Guay

Moerloose

Lasne

2006

Can J Anesth/J Can Anesth

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Purpose: To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed. Methods:The literature was reviewed using the electronic library PUBMED and the Cochrane Database of Systematic Reviews. Relevant studies published in English or French with an English abstract are included. The following keywords were used: children, blood transfusion, surgical blood loss, erythropoietin, autologous blood, red blood cell saver, normovolemic hemodilution, desmopressin, aminocaproic acid, tranexamic acid, aprotinin, cardiac surgery, liver transplantation and scoliosis surgery. Main findings:For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is a safe and effective way to avoid the use of allogenic blood products. For open heart procedures: whole blood of less than 48 hr is helpful for children of less than two years of age undergoing complex procedures; tranexamic acid may be helpful for cyanotic heart disease and, to a lesser degree, for reoperations; while antikallikrein blood levels of aprotinin may both reduce the need for allogenic blood transfusions and improve postoperative oxygenation in infants. Conclusion:Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery. I N normal children perioperative blood loss leading to administration of allogenic transfusion may be encountered if: the surgical site does not allow easy access to surgical hemostasis, the surgery is performed on highly vascularized tissues that are not easily sutured or cauterized (for example bone elements such as in spinal fusion or correction of craniosynostosis) or the surgery itself induces various disturbances of hemostasis (dilution of factors and induction of fibrinolysis as in cardiac surgery with the use of extracorporeal bypass). The pathology justifying the surgical procedure may also induce various coagulation and/or hemostatic abnormalities. Children suffering from congenital cardiac or liver dis- ease may have thrombocytopenia, abnormal platelet function (congenital heart disease) and/or inadequate amounts of various coagulation factors. Objectif1 Perioperative management of children with congenital coagulation and hemostatic diseases will not be discussed in this review. Developmental aspects of hemostasisAn excellent summary of the developmental physiology of coagulation, based mainly on the extensive work of Maureen Andrew, may be found in a recent review by Kuhle et al. and is summarized in Table I.2 Since maternal coagulation factors do not cross the placental barrier, blood levels measured at birth are the result of fetal synthesis that starts around the fifth week of gestation. Fetal blood becomes clottable around 11 weeks of gestation. Except fetal fibrinogen which has an increased content of sialic acid, all coagulation and inhibitor factors are qualitatively normal at birth, and differ from...

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“…However, one randomized prospective study did not show any reduction in blood loss in adolescents undergoing surgery for idiopathic scoliosis 37 . Another study demonstrated a reduction in intraoperative and postoperative blood loss, but not in allogeneic blood transfusion, in patients treated with posterior spine fusion 38 .…”

Section: Aprotininmentioning

confidence: 95%

Reducing Perioperative Blood Loss and Allogeneic Blood Transfusion in Patients Undergoing Major Spine Surgery

Tse¹,

Cheung²,

Ng³

et al. 2011

Journal of Bone and Joint Surgery

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At present, individual techniques, including intraoperative acute normovolemic hemodilution, use of tranexamic acid, use of intrathecal morphine, proper positioning, and modification of operative techniques, seem most promising for reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. Other techniques including preoperative autologous predonation; mandatory discontinuation of use of antiplatelet agents; intraoperative and postoperative red-blood-cell salvage; use of aprotinin, epsilon-aminocaproic acid, recombinant factor VIIa, or desmopressin; induced hypotension; avoidance of hypothermia; and minimally invasive operative techniques require additional studies to either establish their effectiveness or address safety considerations.

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Efficacy of Aprotinin in Reducing Blood Loss in Spinal Fusion for Idiopathic Scoliosis

Cited by 17 publications

References 16 publications

Aprotinin in pediatric neuromuscular scoliosis surgery

Aprotinin in pediatric neuromuscular scoliosis surgery

Réduire les pertes sanguines et les besoins transfusionnels en chirurgie pédiatrique

Reducing Perioperative Blood Loss and Allogeneic Blood Transfusion in Patients Undergoing Major Spine Surgery

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