Use of aprotinin to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis

Backgroud: Conflicting reports have been published regarding the effectiveness and safety of aprotinin in reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of aprotinin in reducing blood loss and transfusion in major orthopedic surgery. Materials and methods: MEDLINE, PubMed, EMBASE and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, and number of transfusions per patient and the summary risk ratio of transfusion requirements, and deep-vein thrombosis (DVT) were calculated in the aprotinin-treated group and the control group. Results: Eighteen randomized controlled trials involving 1276 patients were included. The use of aprotinin reduced total blood loss by a mean of 498.88 ml (95% confidence interval [CI]; -735.03 to -262.72), intra-operative blood loss by a mean of 246.11 ml (95% Cl; -352.11 to -140.11), post-operative blood loss by a mean of 169.11 ml (95% CI; -234.06 to -105.55), the number of blood transfusions per patient by 0.93 units (95% Cl; -136 to -0.51). Aprotinin led to a signficant reduction in transfusion requirements (RR 0.59; 95% Cl; 0.51 to 0.69) and no increase in the risk of DVT (RR 0.58; 95% Cl; 0.38 to 1.08). Conclusion: The meta-analysis shows that aprotinin could significantly reduce blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and it did not appear to increase the risk of DVT. (C) 2014 Elsevier Ltd. All rights reserved.