European Spine Journal

, Volume 17, Issue 12, pp 1671–1675 | Cite as

Aprotinin in pediatric neuromuscular scoliosis surgery

  • Stepan Kasimian
  • David L. Skaggs
  • Wudbhav N. Sankar
  • Joseph Farlo
  • Mashallah Goodarzi
  • Vernon T. Tolo
Original Article

Abstract

Reduction of blood transfusions in patients with neuromuscular scoliosis can decrease potential complications such as immune suppression, infection, hemolytic reaction and viral transmission. Aprotinin (Trasylol®, Bayer), an antifibrinolytic, has proven to be effective in reducing blood loss in cardiac and liver surgery, but little data exists in patients undergoing spinal fusion for neuromuscular scoliosis. The purpose of this study was to evaluate the safety and efficacy of aprotinin in pediatric neuromuscular scoliosis patients undergoing spinal fusion. The medical records of all patients undergoing initial spinal fusions for neuromuscular scoliosis between January 1999 and March 2003 were reviewed to determine demographic data, perioperative data, wound drainage and number of transfusion required. Cases were compared to a matched group of historical controls. We had 14 patients in the aprotinin group and 17 in the control group. Total blood loss in the aprotinin group was significantly lower compared to the control group (715 vs. 2,110 ml; P = 0.007). Significantly less blood loss occurred in the aprotinin group when blood loss per kilogram was evaluated as well (23 vs. 60 ml/kg, respectively; P = 0.002). Intra-operative packed red blood cell (PRBC) transfusions were also significantly lower in the aprotinin group (1.25 vs. 3.16 units; P = 0.001). No clinical evidence of anaphylaxis, deep vein thrombosis (DVT) or renal failure was observed in the aprotinin group. After considering the price of drug therapy, operating room time, and the cost of blood products, the use of aprotinin saved an average of $8,577 per patient. In our series, the use of aprotinin resulted in decreased blood loss and a decreased rate of transfusions in children with neuromuscular scoliosis undergoing extensive spinal fusion. At out institution, the use of aprotinin is safe and cost effective for patients with neuromuscular scoliosis.

Keywords

Aprotinin Antifibrinolytics Blood loss Neuromuscular scoliosis Spinal fusion 

References

  1. 1.
    Cole JW, Murray JD, Snider RJ et al (2003) Aprotinin reduces blood loss during spinal surgery in children. Spine 28(21):2482–2485. doi:10.1097/01.BRS.0000090835.45437.7F PubMedCrossRefGoogle Scholar
  2. 2.
    Dietrich W, Barankay A, Hahnel C et al (1992) High-dose Aprotinin in cardiac surgery: three years’ experience in 1784 patients. J Cardiothorac Vasc Anesth 6(3):324–327. doi:10.1016/1053-0770(92)90150-6 PubMedCrossRefGoogle Scholar
  3. 3.
    FDA Requests Marketing Suspension of Trasylol [U.S. Food and Drug Administration website]. November 5, 2007. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01738.html
  4. 4.
    Guay J, Haig M, Lortie L et al (1994) Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 41:775–781PubMedCrossRefGoogle Scholar
  5. 5.
    Jeserschek R, Aigner C, Rehak P et al (2003) Reduction of blood loss using high-dose Aprotinin in major orthopaedic surgery. J Bone Joint Surg Br 85B:174–177. doi:10.1302/0301-620X.85B2.13303 CrossRefGoogle Scholar
  6. 6.
    Kannan S, Meert KL, Mooney JF et al (2002) Bleeding and coagulation changes during spinal fusion: a comparison of neuromuscular and idiopathic scoliosis patients. Pediatr Crit Care Med 3(4):364–369. doi:10.1097/00130478-200210000-00007 PubMedCrossRefGoogle Scholar
  7. 7.
    Kassell B, Laskowski M Sr (1965) The basic trypsin inhibitor of bovine pancreas. V. The disulfide linkages. Biochem Biophys Res Commun 20:463–468. doi:10.1016/0006-291X(65)90601-7 PubMedCrossRefGoogle Scholar
  8. 8.
    Khoshhal K, Mukhtar I, Clark P et al (2003) Efficacy of Aprotinin in reducing blood loss in spinal fusion for idiopathic scoliosis. J Pediatr Orthop 23:661–664. doi:10.1097/00004694-200309000-00017 PubMedGoogle Scholar
  9. 9.
    Kokoszka A, Kuflik P, Bitan F et al (2005) Evidence-based review of the role of Aprotinin in blood conservation during orthopaedic surgery. J Bone Joint Surg Am 87A(5):1129–1136. doi:10.2106/JBJS.D.02240 CrossRefGoogle Scholar
  10. 10.
    Mangano DT, Tudor IC, Dietzel C (2006) The risk associated with Aprotinin in cardiac surgery. N Engl J Med 354:353–365. doi:10.1056/NEJMoa051379 PubMedCrossRefGoogle Scholar
  11. 11.
    Mannucci PM (1998) Drug therapy: hemostatic drugs. N Engl J Med 339(4):245–253. doi:10.1056/NEJM199807233390407 PubMedCrossRefGoogle Scholar
  12. 12.
    Meert KL, Kannan S, Mooney JF (2002) Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine 27(19):2137–2142. doi:10.1097/00007632-200210010-00012 PubMedCrossRefGoogle Scholar
  13. 13.
    Royston D, Bidstrup BP, Taylor KM et al (1987) Effect of Aprotinin on need for blood transfusion after repeat open heart surgery. Lancet 2:1289–1291. doi:10.1016/S0140-6736(87)91190-1 PubMedCrossRefGoogle Scholar
  14. 14.
    Urban MK, Beckman J, Gordon M et al (2001) The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine 26(10):1152–1156. doi:10.1097/00007632-200105150-00012 PubMedCrossRefGoogle Scholar
  15. 15.
    Van Oeveren W, Jansen NJ, Bidstrup BP et al (1987) Effects of Aprotinin on hemostatic mechanisms during cardiopulmonary bypass. Ann Thorac Surg 44(6):640–645PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Stepan Kasimian
    • 1
  • David L. Skaggs
    • 1
  • Wudbhav N. Sankar
    • 1
  • Joseph Farlo
    • 1
  • Mashallah Goodarzi
    • 1
  • Vernon T. Tolo
    • 1
  1. 1.Children’s Hospital Los AngelesLos AngelesUSA

Personalised recommendations