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Antifibrinolytics in major orthopaedic surgery.

Jason David Eubanks¹

¹Department of Orthopaedic Surgery, University Hospital Case Medical Center, Cleveland, OH, USA.

The Journal of the American Academy of Orthopaedic Surgeons

|March 2, 2010

Summary

Antifibrinolytic medications effectively reduce blood loss and transfusion needs during major surgeries like joint replacement and spinal reconstruction. These drugs work by preventing clot breakdown, offering a safe and cost-effective option for patients.

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Area of Science:

Orthopaedic Surgery
Pharmacology

Background:

Major surgeries like total joint arthroplasty and spinal reconstruction carry a high risk of significant perioperative blood loss.
Pharmacologic agents are being investigated to mitigate this risk.

Purpose of the Study:

To evaluate the efficacy of antifibrinolytic agents in reducing perioperative blood loss and transfusion requirements in complex orthopaedic and spinal surgeries.

Main Methods:

Review of prospective, randomized studies and meta-analyses examining the use of antifibrinolytics (epsilon-aminocaproic acid, tranexamic acid, aprotinin).
Focus on outcomes including blood loss, autologous blood donation, and transfusion rates.

Main Results:

Antifibrinolytics significantly reduce perioperative blood loss and the need for transfusions in total joint arthroplasty, pediatric scoliosis surgery, and adult spinal reconstructive surgery.
Aprotinin use is currently suspended pending further safety evaluations.
Meta-analyses indicate a favorable safety profile with no significant increase in thrombotic events.

Conclusions:

Antifibrinolytic agents are effective and safe in decreasing perioperative blood loss and transfusion requirements for major orthopaedic and spinal surgeries.
These medications offer a valuable strategy for blood management in high-risk surgical procedures.