Aprotinin Decreases Exposure to Allogeneic Blood During Primary Unilateral Total Hip Replacement*

Murkin, John M.; Haig, George M.; Beer, Kelly; Cicutti, Nicholas; Mccutchen, John W.; Comunale, M. E.; Hall, Richard; Ruzicka, Bianca B.

doi:10.2106/00004623-200005000-00008

Cited by 74 publications

(33 citation statements)

References 20 publications

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“…In recent years the use of antifibrinolytic medications such as tranexamic acid (TXA) to decrease blood loss and transfusion has slowly gained popularity in orthopaedics [9,19]. Multiple prospective trials involving patients undergoing TJA have demonstrated a reduction in blood loss and transfusion rates with both TXA and e-aminocaproic acid (EACA) [1,2,4,8,17,20,21,25,26,28]. These results have been One of the authors (MWP) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of USD 100,000 from DePuy (Warsaw, IN, USA), MAKO Surgical Corp (Ft Lauderdale, FL, USA), and Stryker Orthopaedics (Mahwah, NJ, USA).…”

Section: Introductionmentioning

confidence: 99%

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

Whiting

Gillette

Duncan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

104

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Section: Introductionmentioning

confidence: 99%

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

Whiting

Gillette

Duncan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

104

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“…After aprotinin was found to decrease transfusion requirements following cardiopulmonary bypass (CPB) in patients undergoing myocardial revascularization, 68 multiple prospective trials were conducted to analyze antifibrinolytic agents for hemostasis during cardiac surgery. Other major surgical procedures, such as liver transplantation 69,70 and major orthopedic procedures, [71][72][73] have also benefited from antifibrinolytic therapy.…”

Section: Antifibrinolytic Agents: Aprotinin and The Lysine Analoguesmentioning

confidence: 99%

Adjuncts for Tissue stasis

Acheson

Kheirabadi

Holcomb

2005

Transfus Alt Transfus Med

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“…Assuming that the variation in transfusion requirements, and therefore sample size estimation, is similar to that calculated by Lentschener et al [21], the number of adequately powered studies involving patients undergoing orthopedic and spine surgeries is quite limited (Table 1). [2, 14,16,21,24,31]. Based on the findings of two RCTs, desmopressin does not have significant hemostatic activity in association with hip or knee procedures.…”

Section: Sample-size Considerationsmentioning

confidence: 99%

What is the evidence for using hemostatic agents in surgery?

Erstad¹

2004

Eur Spine J

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IntroductionTopical, local, regional, and systemic routes of medication administration have been employed for preventing or reducing blood loss and associated transfusion requirements in patients with bleeding diatheses. Examples would include topical fibrin-or thrombin-based products for wound hemostasis, proton pump inhibitor therapy for preventing gastric rebleeding in patients with peptic ulceration, octreotide derivatives for reducing rebleeding in patients with variceal hemorrhage, and the antifibrinolytic agents and desmopressin for systemic hemostasis. The pharmacological methods used to achieve systemic hemostasis have generated much discussion due to concerns of serious adverse effects (e.g., thromboembolic complications) and costs of therapy in addition to efficacy considerations.The studies that have been conducted have focused on the operating room, where substantial blood loss can often be anticipated. This paper is intended to provide an overview of the consequences and costs of medications used for systemic hemostasis during spine surgery in light of currently available evidence. Ideally, the efficacy and adverse effects of these agents would be defined by large, well-controlled studies restricted to spine surgery rather than by extrapolation from other surgical procedures. Unfortunately, there are a limited number of such trials involving pharmacological hemostasis in association with Abstract The pharmacological methods used to achieve systemic hemostasis have generated much discussion due to concerns of serious adverse effects (e.g., thromboembolic complications) and costs of therapy in addition to efficacy considerations. There are a limited number of well-controlled trials involving pharmacological hemostasis for spine surgery. In the largest doubleblinded randomized controlled trial to date involving spine surgery, there was a trend toward reduced homologous transfusion in patients receiving aprotinin, but the only statistically significant result (p<0.001) was a reduction in autologous red cell donations. The findings of this trial are important, since the investigators used a number of restrictive transfusion strategies (e.g., autologous donation, low hematocrit trigger for transfusion, blood-salvaging procedures with the exception of no cell saver) that were not always employed in earlier trials involving hemostatic agents. Smaller studies involving antifibrinolytic agents other than aprotinin have demonstrated reductions in blood loss and transfusion requirements in patients undergoing spine surgery, although the results were not always statistically significant. A very large randomized trial would be required to address comparative medication-and transfusion-related adverse events; such a trial involving patients undergoing cardiac surgery is currently being performed. Additionally, cost-effectiveness analyses are needed to help define the role of these agents based on the data that is available.

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Aprotinin Decreases Exposure to Allogeneic Blood During Primary Unilateral Total Hip Replacement*

Cited by 74 publications

References 20 publications

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

Adjuncts for Tissue stasis

What is the evidence for using hemostatic agents in surgery?

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