The Efficacy of Antifibrinolytics in the Reduction of Blood Loss During Complex Adult Reconstructive Spine Surgery

Abstract

For complex spinal operations with large blood losses, the half-dose aprotinin regimen will reduce blood loss and the need for blood components and may have a role in reducing postoperative lung injury.

Tests of global haemostasis and their applications in bleeding disorders

“…This has brought about the ability to assess haemostasis with product replacement therapy in such patients [22,23]. Recent studies using thromboelastography have demonstrated the changes in clot growth and disintegration with the use of epsilon amino caproic acid (EACA) [24] in vitro, whereas others have shown the clinical efficacy of antifibrinolytics during surgery to prevent or control bleeding, using thromboelastography [25]. The benefits of using antifibrinolytics in haemophilia with inhibitors and decreased use of APCCÕS have also been shown using thromboelastography [26].…”

Preoperative erythropoietin in spine surgery

“…Addition of rHuEPO therapy to the predonation program allows patients to undergo surgery with haemoglo-S45 Blood management is most difficult in adult patients with complex deformities requiring very aggressive surgery with circumferential approaches and long spinal instrumentation. These patients, comprising group 3 of our series, can present blood losses equal to their total blood volume [79,85]. Shapiro et al [79] published a randomised controlled trial analysing the effect of rHuEPO treatment on patients in an ABD program.…”

“…Surgery for spinal deformities or degenerative lumbar disease may be associated with blood loss ranging from 30% to 100% of the patient's total blood volume [18, 26,68,79,85,87]. This loss of blood is related to the complexity of the procedure, duration of surgery, number of fused levels, anaesthetic technique and the patient's comorbid conditions [18, 26,68,76,79,85,87].…”

“…This loss of blood is related to the complexity of the procedure, duration of surgery, number of fused levels, anaesthetic technique and the patient's comorbid conditions [18, 26,68,76,79,85,87]. Extensive bleeding may lead to rapid fatal consequences and to risks associated with allogenic blood transfusion [4, 8, 36,40,81].…”

“…The most common include drug therapy (desmopressin [2,58], aprotinin [25,85], tranexamic acid [27,65], hypotensive anaesthesia [59,83], and autotransfusion techniques, such as normovolemic acute hemodilution [14,19,56,67], perioperative salvage [3,28,56], postoperative salvage and autologous blood donation (ABD) [39,49,57,64,80,88]. During the 1990s a new drug, recombinant human erythropoietin (rHuEPO), was added to the repertory of blood-conservation techniques [6,9,32,33,73].…”