APROTININ DECREASES BLOOD-LOSS AND HOMOLOGOUS TRANSFUSIONS IN PATIENTS UNDERGOING MAJOR ORTHOPEDIC-SURGERY

Background: Major orthopedic surgery can be associated with dramatic b lood loss, thereby requiring high-volume homologous transfusions in pa tients unable to benefit from blood salvage techniques. The effect of aprotinin on blood loss and transfusion requirements during orthopedic surgery for either the resection of malignancies of the removal of in fected hardware was prospectively studied. Methods: Twenty-three patie nts scheduled for orthopedic surgery of the hip, femur, or pelvis for sepsis or malignant tumors, all under general anesthesia, mere randoml y allocated to receive during operation, in a blinded manner, either a protinin administered as a bolus of 1.10(6) kallikrein inactivation un its (KIU) followed by an infusion of 5 x 10(5) KIU/h, or the equivalen t volume of saline. The anesthesia and perioperative management, as we ll as the designated transfusion criteria, were standardized. The tota l blood loss of each patient was evaluated using intraoperative suctio n losses, sponge weights, and postoperative volumetric drainage. Homol ogous transfusion requirements were noted. Hemoglobin and hematocrit m easures, as well as coagulation and fibrinolytic pathway explorations, were performed before and after surgery. Deep venous thrombosis proph ylaxis was applied, and the incidence of this complication was assesse d. Results: Twelve patients received aprotinin. Aprotinin reduced the total blood loss from a median of 5,305 ml (range, 3,000-9,770 ml) to a median of 1,783 ml (range, 1,140-4,955 ml; P < 0.05). A blood loss r eduction of 56% during surgery and 68% on discharge from the postanest hesia care unit was observed. Seven units (range, 4-16) of packed eryt hrocytes were transfused per patient in the placebo group, and 5 (rang e, 2-5) were transfused in the aprotinin group (P < 0.05). In the apro tinin group, platelet counts were higher, and postoperative prothrombi n times and D. Dimer values were lower. The activated partial thrombop lastin time values showed no significant difference between the two gr oups. No side effects were observed inn the aprotinin group. A deep ve nous thrombosis developed in one patient in the placebo group. Conclus ion: Aprotinin treatment during major orthopedic surgery significantly reduces both blood loss and consequent homologous blood transfusion r equirements.