title: Influence of ultra-low dose Aprotinin on thoracic surgical operations: a prospective randomized trial.
abstract: BACKGROUND
  The blood saving effect of aprotinin has been well documented in cardiac surgery. In thoracic surgery, very few recent studies, using rather high doses of aprotinin, have shown a similar result. In a randomized prospective trial, we have tested the influence of aprotinin using an ultra-low dose drug regime.
  
  
  METHODS
  Fifty-nine patients, mean age 58 +/- 13.25 years (mean +/- SD) undergoing general thoracic procedures were randomized into placebo (Group A) and treatment group (Group B). The group B (n = 29) received 500.000 IU of aprotinin after induction to anesthesia and a repeat dose immediately after chest closure. A detailed protocol with several laboratory parameters was recorded. Patients were transfused when perioperative Ht was less than 26%.
  
  
  RESULTS
  The two groups were similar in terms of age, gender, diagnosis, pathology, co-morbidity and operations performed. The mean drainage of the first and second postoperative day in group B was significantly reduced (412.6 +/- 199.2 vs. 764.3 +/- 213.9 ml, p < 0.000, and 248.3 +/- 178.5 vs. 455.0 +/- 274.6, p < 0.001). Similarly, the need for fresh frozen plasma transfusion was lower in group B, p < 0.035. Both the operation time and the hospital stay were also less for group B but without reaching statistical significance (84.6 +/- 35.2 vs 101.2 +/- 52.45 min. and 5.8 +/- 1.6 vs 7.2 +/- 3.6 days respectively, p < 0.064). The overall transfusion rate did not differ significantly. No side effects of aprotinin were noted.
  
  
  CONCLUSIONS
  The perioperative ultra-low dose aprotinin administration was associated with a reduction of total blood losses and blood product requirements. We therefore consider the use of aprotinin safe and effective in major thoracic surgery.
authors: Department of Cardiothoracic Surgery, Patras University School of Medicine, Patras, Greece. stratisapostolakis@yahoo.gr
authors: Efstratios
authors: E
authors: Apostolakis
authors: Nikolaos
authors: N
authors: Panagopoulos
authors: Efstratios N
authors: EN
authors: Koletsis
authors: James
authors: J
authors: Crockett
authors: Helen
authors: H
authors: Stamou-Kouki
authors: Efrosini
authors: E
authors: Sourgiadaki
authors: Kriton
authors: K
authors: Filos
authors: Dimitrios
authors: D
authors: Dougenis
mesh_terms: D007611:Aprotinin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007430:Intraoperative Care / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013896:Thoracic Diseases / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D007611:Aprotinin