Transfusion Therapy Aprotinin:

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    - Aprotinin:
            - hemostatic agent which regulates the following:
                    - regulates fibrinolysis
                    - intrinsic coagulation pathway
                    - stabilizes platelet function
                    - exhibits anti-inflammatory properties through inhibition of serine proteases;
            - in the report by JM Murkin MD et al (JBJS May 2000, Vol 82-A, No 5 Page 675), the authors performed a multicenter,
                    randomized, placebo-controlled, double-blind trial were to evaluate the efficacy and safety of aprotinin as a
                    blood-sparing agent in patients undergoing an elective primary unilateral total hip replacement and to examine
                    its effect on the prevalence of deep-vein thrombosis in this population.  
                    - 73 patients received a placebo; 76 patients, a low dose of aprotinin (a load
                          of 500,000 kallikrein inhibitor units [KIU]); 75, a medium dose of aprotinin
                          (a load of 1,000,000 KIU, with infusion of 250,000 KIU per hour); and 77 patients,
                          a high dose of aprotinin (a load of 2,000,000 KIU, with infusion of 500,000 KIU per hour);
                    - end points for the determination of efficacy were transfusion requirements and blood loss.
                    - aprotinin reduced the percentages of patients who required any form of blood transfusion (47
                          percent of the patients managed with a placebo needed a transfusion compared with 28 percent of those
                          managed with low-dose aprotinin [p = 0.02], 27 percent of those managed with high-dose aprotinin [p =
                          0.008], and 40 percent of those managed with medium-dose aprotinin [p = 0.5]). Only 6 percent (twelve)
                    - of the 212 patients treated with aprotinin required allogeneic blood compared with 15 percent (ten) of the
                          sixty-eight patients treated with the placebo (p = 0.03).
                    - aprotinin decreased the estimated intraoperative blood loss (p = 0.02 for the low-dose group, p = 0.04 for
                          the medium-dose group, and p = 0.1 for the high-dose group), the measured postoperative drainage volume
                          (p = 0.4 for the low-dose group, p = 0.006 for the medium-dose group, and p = 0.000 for the high-dose group),
                          and the mean reduction in the hemoglobin level on the second postoperative day (thirty-four grams per liter
                          for the placebo group, twenty-eight grams per liter for the low-dose group [p = 0.000], twenty-six grams per
                          liter for the medium-dose group [p = 0.000], and twenty-three grams per liter for the high-dose group [p = 0.000]).
                    - rate of deep-vein thrombosis was similar for all groups.