European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Aprotinin is a potent pharmacological agent that reduces bleeding and limits blood transfusion requirements in current surgical practice. Many studies have been conducted in orthopedic surgery. In several trials performed in total hip replacement (THR) and total knee replacement (TKN) patients, aprotinin only moderately decreased blood-loss-replacement requirements. ⋯ The only major side effect could be the potential occurrence of an anaphylactoid reaction. Prophylactic administration of aprotinin should be considered in extensive spine surgery and in high-risk major orthopedic operations. The decision to use aprotinin should be guided by a risk/benefit analysis.
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The use of local agents to achieve hemostasis is an old and complex subject in surgery. Their use is almost mandatory in spinal surgery. The development of new materials in chemical hemostasis is a continuous process that may potentially lead the surgeon to confusion. ⋯ Using chemical agents to tamponade a hemorrhage is not free of risks. Complications are around the corner and can be due either to mechanical compression or to phlogistic effects secondary to the material used. This paper reviews about 20 animal and clinical published studies with regard to the chemical properties, mechanisms of action, use and complications of local agents.
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Patients who undergo major spinal surgery often require multiple blood transfusions. The antifibrinolytics are medications that can reduce blood-transfusion requirements in cardiac surgery and total knee arthroplasty. The present role of synthetic antifibrinolytics, especially tranexamic acid, in reducing peri-operative blood-transfusion requirements in spine surgery is still unclear. ⋯ The goal of the present review is to discuss the pharmacology of tranexamic acid briefly. A brief synopsis of the studies using the synthetic antifibrinolytics for spine surgery is presented. Finally, the potential risks and the benefits of antifibrinolytics are discussed.
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Patients and physicians continue to be motivated to find methods to reduce the use of allogeneic blood. Even though donor screening has increased the safety of donated blood products, autologous blood is the most desirable source of red cells during the perioperative period. The methods commonly used to obtain autologous blood during the perioperative period can be initiated prior to the operative procedure (autologous preoperative donation, acute normovolemic hemodilution) or during surgery (cell scavenging). ⋯ If operative blood loss is not excessive, the replacement of autologous blood may provide an acceptable red cell mass. In addition to surgical blood loss, some of the key factors in determining how effective acute normovolemic hemodilution will be in limiting allogeneic transfusion are: the patient's initial hematocrit and blood volume; the volume of autologous blood removed prior to the operation; the effectiveness of the hemodilution; and the timing of autologous blood replacement. In contrast to autologous pre-donation, autologous blood removed during acute normovolemic hemodilution is usually stored and re-infused in the operating room.