Miller and coauthors reported the hemostatic and economic effects of aprotinin use in children undergoing repeat cardiac surgery and CPB. The aprotinin-treated group showed reduced blood product transfusions, shortened skin healing time, and shortened intensive care unit and hospital stays. More importantly, patients in the high-dose group ended up with an average cost reduction of nearly $2,500.

Meta-analysis

Levi and his collaborators reported on the three most commonly used drugs to reduce peripheral blood loss (aprotinin, lysine analogs, (aminocaproic acid and Meta-analysis of all randomized, controlled trials of pharmacological strategies for tranexamic acid and desmopressin. Studies were included that reported clinical trials that reported at least one clinically relevant outcome other than peripheral blood loss (mortality, thoracotomy, rate of patients receiving transfusion, or myocardial infarction). In addition, an independent meta-analysis was conducted to study complex cardiac surgery. They identified 72 trials (8409 patients) that met the inclusion criteria. Aprotinin reduced mortality almost twice as much as placebo (OR, 0.55; 95% CI, 0.34-0.90). Aprotinin and lysine analogues reduced the frequency of surgical re-explorations. (OR, 0.37; 95% CI, 0.25-0.55; and OR, 0.44; 95% CI, 0.22-0.90) Both treatments also significantly reduced the proportion of patients receiving any allogeneic blood transfusion. Aprotinin did not increase the risk of myocardial infarction. Levi and colleagues suggested that pharmacological strategies to reduce blood loss during cardiac surgery, particularly with aprotinin and lysine analogues, also reduced mortality, the need for thoracotomy, and the need for patients to undergo blood transfusions. Proportion. In the recent International Study of Perioperative Transfusion Meta-Analysis (ISPOT), they conducted 45 experiments with 5805 patients and confirmed that aprotinin can reduce the need for allogeneic blood transfusion during cardiac surgery. Combining all doses of aprotinin, the overall relative ratio was 0.31 (range, 0.25 to 0.39; p=0.0006)

Aprotinin in multiple double-blind, placebo studies of cardiac surgery and orthopedic surgery It has been extensively evaluated in multicenter studies and is the only agent approved in the United States to reduce bleeding during CABG surgery. From US studies, aprotinin does not increase the risk of myocardial infarction, graft occlusion, stroke or renal insufficiency, and may actually reduce the risk of stroke. The mechanism in this regard is complex, but aprotinin has anti-inflammatory properties due to its complex series of protease inhibition. Like other polypeptides, aprotinin has the risk of allergic reactions, and the danger is not only the first contact, but may occur any time after the first contact. Aprotinin is also safe and effective in reducing blood loss during many plastic surgery procedures. Due to the tissue damage and contact activation that occurs during a large number of orthopedic surgeries, numerous studies have explored the effectiveness and safety of aprotinin. Furthermore, because of the potential risk of thrombotic complications during orthopedic surgery, including deep vein thrombosis, such patients represent an important model in which to evaluate the side effects of hemostatic agents.