Abstract
BackgroundThe blood saving effect of aprotinin has been well documented in cardiac surgery. In thoracic surgery, very few recent studies, using rather high doses of aprotinin, have shown a similar result. In a randomized prospective trial, we have tested the influence of aprotinin using an ultra-low dose drug regime.MethodsFifty-nine patients, mean age 58 ± 13.25 years (mean ± SD) undergoing general thoracic procedures were randomized into placebo (Group A) and treatment group (Group B). The group B (n = 29) received 500.000 IU of aprotinin after induction to anesthesia and a repeat dose immediately after chest closure. A detailed protocol with several laboratory parameters was recorded. Patients were transfused when perioperative Ht was less than 26%.ResultsThe two groups were similar in terms of age, gender, diagnosis, pathology, co-morbidity and operations performed. The mean drainage of the first and second postoperative day in group B was significantly reduced (412.6 ± 199.2 vs. 764.3 ± 213.9 ml, p < 0.000, and 248.3 ± 178.5 vs. 455.0 ± 274.6, p < 0.001). Similarly, the need for fresh frozen plasma transfusion was lower in group B, p < 0.035. Both the operation time and the hospital stay were also less for group B but without reaching statistical significance (84.6 ± 35.2 vs 101.2 ± 52.45 min. and 5.8 ± 1.6 vs 7.2 ± 3.6 days respectively, p < 0.064). The overall transfusion rate did not differ significantly. No side effects of aprotinin were noted.ConclusionThe perioperative ultra-low dose aprotinin administration was associated with a reduction of total blood losses and blood product requirements. We therefore consider the use of aprotinin safe and effective in major thoracic surgery.
Highlights
The blood saving effect of aprotinin has been well documented in cardiac surgery
There was no mortality and there was no significant difference in morbidity
Major complications included lung atelectasis due to sputum retention (n = 1, general thoracic procedures were randomized into placebo (Group A)), acute respiratory failure requiring mechanical ventilation (n = 1, Group B), prolonged air leak lasting more than 10 days (n = 3, two patients for group A and one for group B) and one case of atrial fibrillation
Summary
The blood saving effect of aprotinin has been well documented in cardiac surgery. Very few recent studies, using rather high doses of aprotinin, have shown a similar result. In a randomized prospective trial, we have tested the influence of aprotinin using an ultra-low dose drug regime. Aprotinin is an antifibrinolytic agent, which is widely applied during open-heart operations to reduce the postoperative bleeding [3,4]. The high-cost of high-doses of aprotinin used in cardiac surgery and some lack of definite usefulness in extracardiac operations make the thoracic surgeons hesitant to use it. The aim of our study is to evaluate if ultra-low dose of aprotinin (500.000 IU × 2), has any potential beneficial effect on blood losses and transfusion requirements as well as on the overall hospital outcome after major thoracic operations
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