The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery.
METHODS
Controlled study to assess the efficacy of aprotinin and Amicar in reducing blood loss during complex spinal fusions.


OBJECTIVE
To compare blood loss and the clotting profile with a thromboelastogram in patients with spinal deformities undergoing sequential anterior and posterior spinal fusions treated intraoperatively with either aprotinin or Amicar.


BACKGROUND
Spinal fusion for correction of adult spinal deformities is associated with large blood losses despite the implementation of multiple factors to reduce this blood loss. The antifibrinolytics aprotinin and Amicar have both been shown to reduce blood loss in other surgical procedures with the potential for large blood loss. Hence, we compared their efficacy for reducing blood loss in complex spinal fusions.


METHODS
Sixty patients for elective sequential anteroposterior thoracolumbosacral fusions were randomly assigned to three groups: control, aprotinin, and Amicar. Patients were assessed for blood loss, transfusion requirements, postoperative complications, and coagulation profile using a thromboelastogram.


RESULTS
The study demonstrated a significant reduction in total blood loss (aprotinin 3628 mL, Amicar 4056 mL, control 5181 mL) and transfusion requirements using the half-dose aprotinin regimen compared with Amicar or control. 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 half-dose aprotinin regimen will reduce blood loss and the need for blood components and may have a role in reducing postoperative lung injury.
Urban
M K
MK
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA.
Beckman
J
J
Gordon
M
M
Urquhart
B
B
Boachie-Adjei
O
O
D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008875:Middle Aged; D013123:Spinal Fusion; D013131:Spine / Q000601:surgery*; D013916:Thrombelastography
D000933:Antifibrinolytic Agents; D007611:Aprotinin; D015119:Aminocaproic Acid