What is the evidence for using hemostatic agents in surgery?

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pharmacology

Background:

• Systemic hemostatic agents are debated due to adverse effects, cost, and efficacy concerns.
• Limited well-controlled trials exist for pharmacological hemostasis in spine surgery.
• Previous studies used varied transfusion strategies, impacting antifibrinolytic agent trial results.

Purpose of the Study:

• Evaluate the efficacy of pharmacological hemostasis in spine surgery.
• Assess the impact of antifibrinolytic agents on blood loss and transfusion needs.
• Identify the role of hemostatic agents considering safety, efficacy, and cost-effectiveness.

Main Methods:

• Largest double-blinded randomized controlled trial in spine surgery involving aprotinin.
• Inclusion of restrictive transfusion strategies: autologous donation and low hematocrit triggers.
• Analysis of smaller studies on antifibrinolytic agents other than aprotinin.

Main Results:

• A trend toward reduced homologous transfusion with aprotinin was observed.
• A statistically significant reduction in autologous red cell donations was achieved (p<0.001).
• Smaller studies showed reductions in blood loss and transfusion requirements, though not always significant.

Conclusions:

• Aprotinin demonstrated a significant reduction in autologous red cell donations in spine surgery.
• Antifibrinolytic agents may reduce blood loss and transfusion needs in spine surgery.
• Further large-scale trials and cost-effectiveness analyses are necessary to define the role of these agents.