title: Aprotinin and classic wound drainage are unnecessary in total hip replacement - a prospective randomized trial.
abstract: BACKGROUND
  Classic wound drainage is still common in hip replacement but its benefit is doubtful. The role of systemic administration of proteinase inhibitors like aprotinin to avoid perioperative blood loss is still unclear.
  
  
  METHODS
  In a prospective randomized trial, the perioperative blood loss in alloplastic hip replacement under the influence of proteinase inhibitor (aprotinin, Trasylol®) using wound drainage as well as compression treatment alone were compared. 80 patients were prospectively randomized in 4 arms. Patients received either aprotinin or placebo during surgery as well as drainage or targeted external wound compression.
  
  
  RESULTS
  Observing the "drug therapy" aprotinin had no effect on the intra- or postoperative blood loss (p>0.05), a trend to lower postoperative hemoglobin decline was found, but without significance. Thrombosis occurred in neither the aprotinin nor in the placebo group. Two patients had a severe allergic drug reaction and were excluded from the study. Under "non drug therapy" with compression therapy and wound drainage a significant difference in blood loss was found (p<0.001). The blood loss was higher under the wound drainage. There was no influence on the infection rate. Yet we could observe increased bruising under the sole external compression treatment.
  
  
  CONCLUSIONS
  The administration of aprotinin did not achieve the desired reduction of perioperative blood loss. Hence, costs and two severe allergic drug reactions in our study represent arguments against its use in regular treatment. Furthermore, it seems that wound drainage is neglectable in hip replacement and can be substituted by a sole compression treatment.
authors.affiliation: Department of Surgery, Krankenhaus Bietigheim-Biesingen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Fleischmann
authors.forename: C
authors.initials: C
authors.lastname: Matuschek
authors.forename: K
authors.initials: K
authors.lastname: Orth
authors.forename: P A
authors.initials: PA
authors.lastname: Gerber
authors.forename: R
authors.initials: R
authors.lastname: Mota
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: M
authors.initials: M
authors.lastname: Peiper
authors.forename: M
authors.initials: M
authors.lastname: Schick
authors.forename: M
authors.initials: M
authors.lastname: van Griensven
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.forename: W
authors.initials: W
authors.lastname: Fleischmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001803:Blood Transfusion; D058128:Compression Bandages; D004311:Double-Blind Method; D004906:Erythrocyte Count; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D013396:Suction
chemical_list: D006490:Hemostatics; D007611:Aprotinin