Evidence-based review of the role of aprotinin in blood conservation during orthopaedic surgery.
Aprotinin is a serine protease inhibitor with antifibrinolytic properties that has been approved as a blood-conserving drug in cardiac surgery by the United States Food and Drug Administration. On the basis of the current evidence from Level-I trials, we make a grade-A recommendation for use of the high-dose aprotinin regimen in hip and spine surgery. Because of conflicting data, the low-dose aprotinin therapy as well as the use of aprotinin in patients with cancer cannot be recommended (grade-I recommendation). High-quality randomized trials are necessary to determine the optimal (and minimal) therapeutic dose of aprotinin and the optimal time of aprotinin administration during surgery.
Kokoszka
Agnieszka
A
Spine Institute, Beth Israel Medical Center, New York, NY 10003, USA. agnieszka.kokoszka@mail.hsc.sunysb.edu
Kuflik
Paul
P
Bitan
Fabien
F
Casden
Andrew
A
Neuwirth
Michael
M
D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006615:Hip / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures; D016032:Randomized Controlled Trials as Topic; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013131:Spine / Q000601:surgery
D015842:Serine Proteinase Inhibitors; D007611:Aprotinin