The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery

Study Design. Controlled study to assess the efficacy of aprotinin and Amic ar in reducing blood loss during complex spinal fusions. Objectives. To compare blood loss and the clotting profile with a thromboel astogram in patients with spinal deformities undergoing sequential anterior and posterior spinal fusions treated intraoperatively with either aprotini n or Amicar. Summary of Background Data. Spinal fusion for correction of adult spinal de formities is associated with large blood losses despite the implementation of multiple factors to reduce this blood loss. The antifibrinolytics aproti nin and Amicar have both been shown to reduce blood loss in other surgical procedures with the potential for large blood loss. Hence, we compared thei r efficacy for reducing blood loss in complex spinal fusions. Methods. Sixty patients for elective sequential anteroposterior thoracolumb osacral fusions were randomly assigned to three groups: control, aprotinin, and Amicar. Patients were assessed for blood loss, transfusion requirement s, postoperative complications, and coagulation profile using a thromboelas togram. Results. The study demonstrated a significant reduction in total blood loss (aprotinin 3628 mL, Amicar 4056 mL, control 5181 mL) and transfusion requi rements using the half-dose aprotinin regimen compared with Amicar or contr ol. Aprotinin also preserved the thromboelastogram mean clot formation time , clot strength, and clotting index compared with Amicar or control. Conclusions. For complex spinal operations with large blood losses, the hal f-dose aprotinin regimen will reduce blood loss and the need for blood comp onents and may have a role in reducing postoperative lung injury.