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

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%.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.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.The incidence of postoperative hemorrhage after cardiopulmonary bypass is about 5–7% and after pulmonary resections is somewhat lower, about 4.6% [1,2]. Aprotinin is an antifibrinolytic agent, which is widely applied during open-heart operations to reduce the postoperative bleeding [3,4]. The high-cost of high-doses of aprotinin used in cardiac surgery and some lack of definite usefulness in extracardiac operations make the thoracic surgeons hesitant to use it. In fact, its use in extracardiac thoracic operations has so far only been tested in a few studies [5-7]. It has been established that the perioperative blood