Use of aprotinin in extrapleural pneumonectomy: effect on hemostasis and incidence of complications.
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.
Bakaeen
Faisal
F
The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA. fbakaeen@bcm.edu
Rice
David
D
Correa
Arlene M
AM
Walsh
Garrett L
GL
Vaporciyan
Ara A
AA
Putnam
Joe B
JB
Swisher
Stephen G
SG
Roth
Jack A
JA
Huh
Joe
J
Chu
Danny
D
Smythe
W Roy
WR
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
D006490:Hemostatics; D007611:Aprotinin