Aprotinin and major orthopedic surgery.
Aprotinin is a potent pharmacological agent that reduces bleeding and limits blood transfusion requirements in current surgical practice. Many studies have been conducted in orthopedic surgery. In several trials performed in total hip replacement (THR) and total knee replacement (TKN) patients, aprotinin only moderately decreased blood-loss-replacement requirements. Conversely, when aprotinin was used in patients at high risk for bleeding (cancer, sepsis, redone surgery), it developed a potent hemostatic activity and decreased blood transfusion significantly. No increase in deep vein thrombosis and pulmonary embolism was observed. The only major side effect could be the potential occurrence of an anaphylactoid reaction. Prophylactic administration of aprotinin should be considered in extensive spine surgery and in high-risk major orthopedic operations. The decision to use aprotinin should be guided by a risk/benefit analysis.
Samama
Charles Marc
CM
Département d'Anesthésie-Réanimation, Hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny cedex, France. cmsamama@invivo.edu.
D007611:Aprotinin / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013123:Spinal Fusion / Q000009:adverse effects; D013927:Thrombosis / Q000139:chemically induced; D016896:Treatment Outcome
D006490:Hemostatics; D007611:Aprotinin