title: Use of aprotinin in extrapleural pneumonectomy: effect on hemostasis and incidence of complications.
abstract: BACKGROUND
  The purpose of this study was to examine the effect of aprotinin on blood loss in extrapleural pneumonectomy and to identify potential treatment-related complications.
  
  
  METHODS
  Between March 1, 1999, and July 1, 2004, 27 (52%) of 52 patients who underwent extrapleural pneumonectomy received half-dose aprotinin (1 million kallikrein inhibition units load; 250,000 kallikrein inhibition units per hour infusion). A retrospective data review and analysis were performed.
  
  
  RESULTS
  The mean age was 59.8 +/- 11 years, and 45 of 52 patients (87%) were male. Indications for extrapleural pneumonectomy were malignant pleural mesothelioma (n = 50) and pleural-based sarcoma (n = 2). The administration of aprotinin had no significant effect on intraoperative blood loss (1,010 +/- 599 versus 1,182 +/- 688 mL; p = 0.34) or units of packed red blood cells transfused intraoperatively (2.0 +/- 1.7 versus 1.9 +/- 1.7 units; p = 0.86). None of the patients who received aprotinin required the use of non-packed red blood cells blood products, but 4 patients (16%) who did not receive aprotinin required such transfusion (p < 0.05). Postoperative chest tube output at 12 and 24 hours was lower in the aprotinin group (381 +/- 195 and 867 +/- 313 mL, respectively) compared with the control group (725 +/- 527 and 1,221 +/- 442 mL, respectively; p < 0.03). There was no significant difference in incidence of postoperative thromboembolic events between the aprotinin and the control group (5 versus 4 patients; p = 1.0), and 2 patients in each group experienced renal insufficiency (p = 1.0).
  
  
  CONCLUSIONS
  Half-dose aprotinin did not decrease intraoperative blood loss or packed red blood cells transfusion in extrapleural pneumonectomy. However, use of aprotinin was associated with decreased use of non-packed red blood cells blood products and lower postoperative chest tube output. Aprotinin administration was not associated with an increase in incidence of postoperative complications.
authors.affiliation: The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA. fbakaeen@bcm.edu
authors.forename: Faisal
authors.initials: F
authors.lastname: Bakaeen
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Joe
authors.initials: J
authors.lastname: Huh
authors.forename: Danny
authors.initials: D
authors.lastname: Chu
authors.forename: W Roy
authors.initials: WR
authors.lastname: Smythe
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000009:adverse effects / Q000627:therapeutic use*; D001803:Blood Transfusion; D016527:Drug Costs; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D006490:Hemostatics; D007611:Aprotinin