Haemostatic effect of aprotinin during craniosynostotic surgery in children

Abstract

Blood loss and need for blood transfusion were significantly reduced in the aprotinin group. No allergic or other possible aprotinin-specific complications were registered in the aprotinin group.

Safety and efficacy of aprotinin versus tranexamic acid for reducing absolute blood loss and transfusion in pediatric patients undergoing craniosynostosis surgery: a randomized, double-blind, three-arm controlled trial

“…However, the subgroup analysis on randomized controlled trials showed that patients in the TXA group did not have significantly reduced blood loss during surgery compared with patients in the placebo group (p = 0.14). 7 In the current study, only 10% of patients in the TXA group received PRBCs after the operation, a rate that was lower than the rate observed in a previous study by Ongun et al (23.5%) 14 and higher than the rate reported in a study by Goobie et al (0%). 8 The postoperative EBV loss after 8 hours was significantly lower in the TXA group than in the control group, as similarly shown by Goobie et al (median 3 ml/kg vs 12 ml/kg); 8 however, the difference was not significant in other previous studies.…”

“…The median values of blood loss and requirement for blood transfusion during the operation decreased from 22% to 3.9% and 21.1% to 0%, respectively, in the treatment group compared with the control group (p < 0.001). 7 While a similar study had shown that estimated blood loss was not significantly lower in the aprotinin group, this study also showed that the intraoperative and first 3-day postoperative rates of blood transfusion were significantly lower in the aprotinin group (32 vs 52 and 33 vs 57 ml/kg, respectively, p = 0.03). 11 According to Ahmed et al in 2014, administration of aprotinin for pediatric craniofacial surgeries resulted in significantly less colloid administration and blood transfusion in the aprotinin-treated group (p < 0.003).…”

“…6 Blood transfusion carries potential inherent risks, including viral infection and lung injuries. 7 Moreover, massive transfusion and its consequences, especially in pediatric patients whose EBV is lower than that of adults, are other major concerns for the surgical team. Technique modification and less invasive procedures may help reduce bleeding.…”

“…Technique modification and less invasive procedures may help reduce bleeding. 7 Moreover, a number of pharmacological agents and factors to reduce perioperative blood loss and transfusion have been widely proposed and tested, including recombinant factor VII, fibrinogen, tranexamic acid (TXA; trans-4-aminomethyl cyclohexane carboxylic acid), and aprotinin. Use of recombinant erythropoietin to increase the red cell mass has also been reported.…”

“…Use of recombinant erythropoietin to increase the red cell mass has also been reported. 7 In the current investigation, the effects of aprotinin and TXA on absolute blood loss and transfusion were assessed in pediatric patients undergoing craniosynostosis surgery.…”