Efficacy of Aprotinin as a Blood Conservation Technique for Adult Deformity Spinal Surgery

Tayyab, Neil; Mariller, Marjorie M.; Rivlin, Michael; Berekashvili, Ketevan; Bitan, Fabien D.; Casden, Andrew M.; Kuflik, Paul; Neuwirth, Michael G.

doi:10.1097/brs.0b013e31817b87c4

Cited by 14 publications

(10 citation statements)

References 17 publications

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“…Given the resemblance between our study and that of Tayyab et al (18) it can be concluded that aprotinin or controlled hypotension are effective in bleeding reduction in spinal surgeries. Bai et al (2008) investigated the severity of blood loss in neurosurgeries in three groups (control group, hemodilution with controlled hypotension and hemodilution with aprotinin), finding that despite reduced intraoperative bleeding, there was not any significant difference between the two groups (19).…”

Section: Discussionsupporting

confidence: 81%

“…In a similar study, Tayyab et al (2008) examined the effect of aprotinin on reducing blood loss in spinal deformity correction surgery in 82 patients, concluding that it reduced blood loss and the need for blood transfusion (18). Given the resemblance between our study and that of Tayyab et al (18) it can be concluded that aprotinin or controlled hypotension are effective in bleeding reduction in spinal surgeries.…”

Section: Discussionmentioning

confidence: 52%

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Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Fathi¹,

Jahanbakhsh²,

Bameshki³

et al. 2015

Razavi Int J Med

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Background: Methods of reducing blood loss in surgical procedures such as spinal disc herniation, which are characterized by severe bleeding, can reduce the need for blood transfusion and thereby the risk of infectious diseases transmission, transfusion reactions, acute lung injury, graft-versus-host disease (GVHD), hypothermia, coagulation disorders and metabolic complications. Anti-fibrinolytic drugs (e.g. Aprotinin, aminocaproic acid, desmopressin and tranexamic acid) and controlled hypotension (monitored reduction by medication) are among these methods. Objectives: In our clinical trial, two methods of aprotinin and controlled hypotension are compared in terms of their efficacy in reducing blood loss. Patients and Methods: 70 patients undergoing spinal disc herniation were randomly divided into two groups of controlled hypotension (treated with nitroglycerin: starting with 5 µg/minute to reach an MAP of 55 -60 mmHg, with an increase of 5 µg/minute of the drug in every 3 -5 minutes) and aprotinin (0.5 million units injection before surgery). The anesthesia was administered similarly to both groups and blood pressure and heart rate were recorded every 5 to 15 minutes. Moreover, the amount of bleeding and the surgeon satisfaction were measured. Results: 70 patients were identical in terms of demographics and the length of surgery. The two groups were not statistically different in terms of mean change in systolic, diastolic and mean blood pressure and heart rate at different times. The severity of blood loss measured on Boezarrt scale for low, medium and severe bleeding was respectively 21 (30%), 27 (39%), and 12 (31%). The extent of surgeon satisfaction with the operation room measured on a 3-point Likert scale (poor, medium and good) was 18 (26%), 40 (57%), and 12 (17%), respectively. The results were almost corresponding in both groups. Also, the two groups were identical in terms of calculated blood loss and the need for additional intraoperative medication. Conclusions: In intervertebral herniated disc surgery, aprotinin and controlled hypotension treatments yielded similar results in terms of reducing blood loss and surgeon satisfaction with the field of operation.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 52%

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Fathi¹,

Jahanbakhsh²,

Bameshki³

et al. 2015

Razavi Int J Med

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show abstract

“…The study found 43% reduction in autologous blood transfusion and 46% reduction in allogenic blood transfusion with the use of aprotinin. However, tranexamic acid was not evaluated in that study [24]. Kasimian et al [25] found aprotinin to be safe and cost effective for patients with neuromuscular scoliosis.…”

Section: Discussionmentioning

confidence: 95%

“…Establishing the safety of the antifibrinolytic agents in the adult patients is therefore of much importance. In a retrospective study on adult spinal deformity surgeries, Tayyab et al [24] concluded aprotinin to be safe and effective in adult spinal deformity correction surgery. The study found 43% reduction in autologous blood transfusion and 46% reduction in allogenic blood transfusion with the use of aprotinin.…”

Section: Discussionmentioning

confidence: 99%

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery

et al. 2012

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“…Previous controlled studies demonstrated a reduction in blood loss and transfusion requirements in adult patients undergoing spine reconstruction surgery 33 and in children and adolescents undergoing spine surgery with fusions to correct deformity 34 . More recent studies also demonstrated promising results with regard to decreasing blood loss and the need for allogeneic blood transfusion in adults undergoing spine surgery to correct deformity and those undergoing surgery to address neuromuscular scoliosis 35,36 .…”

Section: Aprotininmentioning

confidence: 99%

Reducing Perioperative Blood Loss and Allogeneic Blood Transfusion in Patients Undergoing Major Spine Surgery

Tse¹,

Cheung²,

Ng³

et al. 2011

Journal of Bone and Joint Surgery

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At present, individual techniques, including intraoperative acute normovolemic hemodilution, use of tranexamic acid, use of intrathecal morphine, proper positioning, and modification of operative techniques, seem most promising for reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. Other techniques including preoperative autologous predonation; mandatory discontinuation of use of antiplatelet agents; intraoperative and postoperative red-blood-cell salvage; use of aprotinin, epsilon-aminocaproic acid, recombinant factor VIIa, or desmopressin; induced hypotension; avoidance of hypothermia; and minimally invasive operative techniques require additional studies to either establish their effectiveness or address safety considerations.

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Efficacy of Aprotinin as a Blood Conservation Technique for Adult Deformity Spinal Surgery

Cited by 14 publications

References 17 publications

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Comparison of Aprotinin and Controlled Hypotension on Blood Loss in the Herniated Intervertebral Disc Surgery

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery

Reducing Perioperative Blood Loss and Allogeneic Blood Transfusion in Patients Undergoing Major Spine Surgery

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