title: Use of aprotinin to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis.
abstract: BACKGROUND
  Conflicting reports have been published regarding the effectiveness and safety of aprotinin in reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of aprotinin in reducing blood loss and transfusion in major orthopedic surgery.
  
  
  METHODS
  MEDLINE, PubMed, EMBASE and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, and number of transfusions per patient and the summary risk ratio of transfusion requirements, and deep-vein thrombosis (DVT) were calculated in the aprotinin-treated group and the control group.
  
  
  RESULTS
  Eighteen randomized controlled trials involving 1276 patients were included. The use of aprotinin reduced total blood loss by a mean of 498.88 ml (95% confidence interval [CI]; -735.03 to -262.72), intra-operative blood loss by a mean of 246.11 ml (95% CI; -352.11 to -140.11), post-operative blood loss by a mean of 169.11 ml (95% CI; -234.06 to -105.55), the number of blood transfusions per patient by 0.93 units (95% CI; -1.36 to -0.51). Aprotinin led to a signficant reduction in transfusion requirements (RR 0.59; 95% CI; 0.51 to 0.69) and no increase in the risk of DVT (RR 0.58; 95% CI; 0.38 to 1.08).
  
  
  CONCLUSIONS
  The meta-analysis shows that aprotinin could significantly reduce blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and it did not appear to increase the risk of DVT.
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Binzhou People's Hospital, Binzhou, China.
authors.forename: Quancheng
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of General Surgery, Binzhou People's Hospital, Binzhou, China.
authors.forename: Chongyong
authors.initials: C
authors.lastname: Guo
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China. Electronic address: maguangwen2013@126.com.
authors.forename: Guangwen
authors.initials: G
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Wu
mesh_terms: D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D016239:MEDLINE; D008297:Male; D019637:Orthopedic Procedures; D016032:Randomized Controlled Trials as Topic
chemical_list: D006490:Hemostatics; D007611:Aprotinin
keywords: Aprotinin; Blood loss; Meta-analysis; Transfusion