Antifibrinolytic therapy and perioperative blood loss in cancer patients undergoing major orthopedic surgery.
BACKGROUND
Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether epsilon amino-caproic acid (EACA) is effective in this population are sparse.


METHODS
Sixty-nine adults with malignancy scheduled for either pelvic, extremity or spine surgery during general anesthesia entered this randomized, double-blind, placebo-controlled trial, and received either intravenous aprotinin (n = 23), bolus of 2 x 10(6) kallikrein inactivator units (KIU), followed by an infusion of 5 x 10(5) KIU/h, or EACA (n = 22), bolus of 150 mg/kg, followed by a 15 mg/kg/h infusion or saline placebo (n = 24) during surgery. Our goal was to determine whether prophylactic EACA or aprotinin therapy would reduce perioperative blood loss (intraoperative + first 48h) >30% when compared to placebo.


RESULTS
The mean age of the study population was 52 +/- 17 yr. The groups did not differ in age, duration of surgery, perioperative blood loss or number of packed erythrocyte units transfused. When compared to the placebo group, the two treated groups had a significantly lower D-Dimer level immediately after surgery, P < 0.01.


CONCLUSIONS
Under the conditions of this study, we were unable to find a clinical benefit to using aprotinin or EACA to reduce perioperative blood loss or transfusion requirements during major orthopedic surgery in cancer patients.
Amar
David
D
Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, New York 10021, USA. amard@mskcc.org
Grant
Florence M
FM
Zhang
Hao
H
Boland
Patrick J
PJ
Leung
Denis H
DH
Healey
John A
JA
D000368:Aged; D015119:Aminocaproic Acid / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use; D001772:Blood Cell Count; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D019637:Orthopedic Procedures; D018401:Sample Size; D020246:Venous Thrombosis / Q000188:drug therapy
D000933:Antifibrinolytic Agents; D007611:Aprotinin; D015119:Aminocaproic Acid