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Aprotinin reduces blood loss during spinal surgery in children
Jennifer W Cole1, David J Murray, Rebecca J Snider
1Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA. colejw@msnotes.wustl.edu
Insights
Aprotinin significantly reduced blood loss and transfusion needs in pediatric spinal fusion surgery. This study shows its potential to improve outcomes for children undergoing complex spinal procedures.
Area of Science:
- Pediatric Orthopedics
- Surgical Hemorrhage Control
- Pharmacological Interventions
Background:
- Significant blood loss is a primary concern during long segment spinal fusions in children.
- Existing methods to mitigate bleeding have limitations.
- Aprotinin, an antifibrinolytic, has demonstrated efficacy in reducing blood loss in other surgical contexts.
Purpose of the Study:
- To evaluate the effectiveness of aprotinin in minimizing blood loss.
- To assess the impact of aprotinin on transfusion requirements during pediatric spinal fusion.
- To determine if aprotinin improves outcomes in patients undergoing extensive posterior spinal fusions.
Main Methods:
- Prospective, blinded, randomized controlled trial involving 44 pediatric patients.
- Perioperative infusion of high-dose aprotinin versus placebo.
- Assessment of estimated blood loss, transfusion volume, ICU stay, and hospitalization duration.
Main Results:
- Aprotinin group: 545 cc estimated blood loss and 1.1 units transfused.
- Placebo group: 930 cc estimated blood loss and 2.2 units transfused.
- No significant difference in ICU or hospital length of stay between groups.
Conclusions:
- Aprotinin significantly reduces intraoperative blood loss in pediatric scoliosis surgery.
- Aprotinin decreases the need for blood transfusions in high-risk pediatric spinal fusion patients.
- Aprotinin is a promising agent for managing bleeding during complex pediatric spinal surgeries.
Study Design:
A prospective blinded, randomized controlled study compared the effect of a perioperative infusion of aprotinin versus placebo during long segment spinal fusions in children.
Objectives:
To determine whether aprotinin decreases blood loss and transfusion requirements in pediatric patients with spinal deformities undergoing posterior spinal fusions of seven or greater segments.
Summary Of Background Data:
Blood loss is a major cause of morbidity during long segment spinal fusion. Several preoperative and intraoperative techniques are currently used to reduce blood loss and transfusion requirements. Aprotinin, an antifibrinolytic and anti-inflammatory agent, has been used to decrease blood loss in cardiac surgical patients. We designed a prospective, randomized, and blinded controlled study to evaluate aprotinin's efficacy in reducing bleeding during pediatric spine surgery.
Methods:
After obtaining informed written consent, we studied 44 children and adolescents who were anticipated to be at higher risk for major blood loss during posterior spinal fusion. Children were randomly assigned to receive high dose aprotinin or placebo infusion during the perioperative period. Patients were assessed for blood loss, transfusion requirements, days in the intensive care unit, and days in hospital.
Results:
Demographics in the two groups of patients were similar. The study demonstrated a significant reduction in estimated blood loss (aprotinin 545 cc, placebo 930 cc) and transfusion requirements (aprotinin 1.1 U, placebo 2.2 U). The duration of intensive care unit admission was similar in the two groups, as was the time until discharge.
Conclusions:
This randomized, blinded study suggests that aprotinin significantly decreased blood loss and transfusion requirements in pediatric and adolescent scoliosis surgical patients at increased risk for intraoperative bleeding.