Influence of ultra-low dose Aprotinin on thoracic surgical operations: a prospective randomized trial

Efstratios Apostolakis^*¹ , Nikolaos Panagopoulos^*¹ , Efstratios N Koletsis^*¹ , James Crockett^*¹ , Helen Stamou-Kouki^*¹ , Efrosini Sourgiadaki^*² , Kriton Filos^*² and Dimitrios Dougenis^*¹

¹Department of Cardiothoracic Surgery, Patras University School of Medicine, Patras, Greece

²Department of Anesthesiology, Patras University School of Medicine, Patras, Greece

author email corresponding author email* Contributed equally

Journal of Cardiothoracic Surgery 2008, 3:14doi:10.1186/1749-8090-3-14


Published:	24 March 2008

Abstract

Background

The 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.

Methods

Fifty-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%.

Results

The 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.

Conclusion

The 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.