title: Efficacy of aprotinin as a blood conservation technique for adult deformity spinal surgery: a retrospective study.
abstract: METHODS
  A retrospective study that involved a total of 82 adult deformity patients who underwent spinal fusion surgery with instrumentation of 6 or more levels.
  
  
  OBJECTIVE
  The purpose of this study is to assess the efficacy and safety of aprotinin in reducing blood loss in adult spinal deformity patients.
  
  
  BACKGROUND
  Aprotinin is an antifibrinolytic agent, which has been proven to be effective as a blood-conserving agent in cardiac surgery. This study focused specifically on adult spine deformity patients.
  
  
  METHODS
  This retrospective study analyzed a total of 82 adult deformity patients (patients with diagnosis of adult scoliosis and kyphosis) who underwent spinal fusion surgery with instrumentation of 6 or more levels. Forty-one patients who received aprotinin were compared with a control group of 41 patients who did not receive aprotinin. Specific surgical outcome parameters and postoperative complications were assessed.
  
  
  RESULTS
  The average age of the patients was 47 years and 41 years for the aprotinin group and the control group respectively. Thirty-nine percent of cases and 44% of controls had staged anterior/posterior fusion surgery, 39% of cases and 41% of controls underwent single stage posterior fusion surgery and the remaining 27% of cases and 15% of controls had same day anterior and posterior fusion surgery. The average number of levels fused and instrumented was 11.2 for the aprotinin group and 10.7 for the control group. The differences in mean blood loss and blood returned by cell-saver were statistically significantly lower in the aprotinin group (1324 mL vs. 2113 mL; P = 0.005 and 390 mL vs. 657 mL; P = 0.003). The amount of drainage after surgery was similar (1421 mL vs. 1388 mL; P = 0.982). The aprotinin group received an average of 2.73 units of blood. This was significantly lower than the average 5.02 units that the controls received (P = 0.003). The rate of complications was comparable and no allergic reaction to aprotinin was noted. One case exhibited a transitory elevation of blood urea nitrogen/creatinine which resolved before discharge.
  
  
  CONCLUSIONS
  The results of our study suggest that the administration of aprotinin is a safe and effective method to reduce blood loss and to decrease the need for transfusions without increasing risk of complication in the younger patients in relatively good general health undergoing spinal deformity surgery requiring 6 or more levels of fusion.
authors.affiliation: Beth Israel Medical Center/Spine Institute, New York, New York 10003, USA. ntayya1@yahoo.com
authors.forename: Neil Arif
authors.initials: NA
authors.lastname: Tayyab
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Mariller
authors.forename: Michael
authors.initials: M
authors.lastname: Rivlin
authors.forename: Ketevan
authors.initials: K
authors.lastname: Berekashvili
authors.forename: Fabien D
authors.initials: FD
authors.lastname: Bitan
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Casden
authors.forename: Paul
authors.initials: P
authors.lastname: Kuflik
authors.forename: Michael G
authors.initials: MG
authors.lastname: Neuwirth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013116:Spinal Cord / Q000002:abnormalities* / Q000187:drug effects / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000188:drug therapy / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods
chemical_list: D006490:Hemostatics; D007611:Aprotinin