EFFECTS OF APROTININ APPLICATION ON PERIOPERATIVE CHANGES IN HEMOSTASIS AND FIBRINOLYSIS AND ITS CONSEQUENCE FOR BLOOD-LOSS AND TRANSFUSIONREQUIREMENT IN LUNG SURGERY

Objective: To investigate the usefulness of aprotinin treat ment durin g thoracic surgery of malignant lung disease. Design: In a prospective , placebo-controlled, double-blind pilot study parameters of coagulati on, fibrinolysis, and platelets were examined on samples taken before, during and after surgery. Furthermore, the blood loss and the consump tion of red cell concentrates were measured perioperatively. Patients: 24 male patients, who underwent thoracic surgery (because of malignan t lung disease), were randomized into two groups. Treatment: The treat ment group received a bolus of 2 x 10(6) kallikrein inhibitor units (K IU) aprotinin (Antagosan (R)) followed by 0,5 x 10(6) KIU/h of aprotin in during surgery until 1 h after surgery. The placebo group was infus ed with isotonic saline instead. Results: Parameters of coagulation an d platelets showed no statistically significant differences between tr eatment and placebo groups. Fibrinolysis parameters showed remarkable differences between both groups (plate of fibrin, t-PA antigen, plasmi nogen, PAI, alpha(2)-antiplasmin, PAP, FDP, D dimers). The intraoperat ive activation of fibrinolysis was noticeably inhibited in the treatme nt group. Blood loss (treatment group 726 ml, placebo group 1,699 ml) and consumption of red cell concentrates (treatment group 1 patient ob taining 1 concentrate, placebo group: 16 patients obtaining a total of 16 concentrates) were considerably reduced in the treatment group. Co nclusions: The use of aprotinin for thoracic surgery without extracorp oreal circulation appears to be a suitable procedure to reduce the blo od loss and the consumption of heterologous blood donations.