Hemostatic drugs in trauma and orthopedic practice

Abstract

a naturally occurring serine protease inhibitor, is found in the mast cells of all mammalian species as well as many lower orders of life. Unfortunately, at this time, we do not understand the true physiological role of aprotinin in nature. What is known is that the use of high doses of the drug inhibits a number of the inflammatory processes involved with open heart surgery and also modifies the hemostatic system to allow reductions in bleeding and thus the need for blood and blood products. The use of high-dose aprotinin therapy followed reports of the potential benefit of this approach in patients following trauma. 1 Largedose aprotinin therapy has been shown to be extremely effective and safe in preventing blood loss and the need for blood and blood products in patients undergoing open heart surgery. The current literature contains more than 40 reports of randomized placebo-controlled studies 2'3 showing that lfigh-dose aprotinin therapy reduced drain losses (range, 35% to 81%), the total amount of transfusions (range, 35% to 97%), and the proportion of patients requiring transfusions of blood or blood products (range, 40% to 88%). Since the first description of the hemostatic actions of high-dose aprotinin therapy in patients undergoing reoperation 4 or high-risk cardiac procedures, this agent has been the standard of care in this situation and is the only product licensed for use for this indication in North America. The aim of this article is to discuss the potential for the anti-inflammatory and hemostatic action to benefit patients undergoing elective orthopedic and trauma surgery and also following trauma itself. The article is divided into three sections: (1) the use of drugs to prevent bleeding during elective