Aprotinin Decreases Blood Loss in Complex Adult Spinal Deformity but Increases the Risk of Acute Renal Failure

Methods: Adult spinal deformity patients undergoing long spinal arthrodesis at one institution between 2001 and 2005 were analyzed. The patients were matched according to age and type of procedure performed. 40 patients received high-dose Aprotinin (Group A) intraoperatively and 41 patients were matched as controls (Group NA) who did not receive Aprotinin. Outcome variables included intraoperative blood loss and postoperative complications.

Results: The average age of the Group A patients was 50.9 years and 50.4 years for Group NA. Levels fused were 10.6 for Group A and 9.2 for Group NA. Average osteotomies were 0.35 PSO and 1.98 SPO for Group A and 0.32 PSO and 1.24 SPO for Group NA. Average blood loss for Group A was 710ml and 978ml for Group NA. The difference was statistically significant with a p<0 .05. Complications seen in Group A included four cases of acute renal failure (ARF) requiring dialysis and one DVT. In NA, there was only case (secondary to gentamicin) pulmonary embolus. The patients with ARF were female, aged 61 - 73 years old, various comorbidities. All required inpatient hemodialysis, three averaged two months continued outpatient before resolution compromise. One patient is on chronic dialysis.

Conclusion: In long spinal arthrodesis in complex adult spinal deformity surgery, Aprotinin does reduce intraoperative blood loss but also substantially increases the risk of acute renal failure.

Statistically Significant with p‹0.05

** The FDA has not cleared a drug and/or medical device described in this presentation (i.e., the drug or medical device is being discussed in an (off-label use.)