What is the evidence for using hemostatic agents in surgery?

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

The pharmacological methods used to achieve systemic hemostasis have generated much discussion due to concerns of serious adverse effects (e.g., thromboembolic complications) and costs of therapy in addition to efficacy considerations. There are a limited number of well-controlled trials involving pharmacological hemostasis for spine surgery. In the largest double-blinded randomized controlled trial to date involving spine surgery, there was a trend toward reduced homologous transfusion in patients receiving aprotinin, but the only statistically significant result (p<0.001) was a reduction in autologous red cell donations. The findings of this trial are important, since the investigators used a number of restrictive transfusion strategies (e.g., autologous donation, low hematocrit trigger for transfusion, blood-salvaging procedures with the exception of no cell saver) that were not always employed in earlier trials involving hemostatic agents. Smaller studies involving antifibrinolytic agents other than aprotinin have demonstrated reductions in blood loss and transfusion requirements in patients undergoing spine surgery, although the results were not always statistically significant. A very large randomized trial would be required to address comparative medication- and transfusion-related adverse events; such a trial involving patients undergoing cardiac surgery is currently being performed. Additionally, cost-effectiveness analyses are needed to help define the role of these agents based on the data that is available.

Original languageEnglish (US)
JournalEuropean Spine Journal
Volume13
Issue numberSUPPL. 1
DOIs
StatePublished - Oct 2004

Fingerprint

Hemostatics
Aprotinin
Spine
Hemostasis
Blood Transfusion
Pharmacology
Antifibrinolytic Agents
Hematocrit
Thoracic Surgery
Cost-Benefit Analysis
Randomized Controlled Trials
Research Personnel
Costs and Cost Analysis
Therapeutics

Keywords

  • Antifibrinolytic agents
  • Hemorrhage
  • Hemostatics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

What is the evidence for using hemostatic agents in surgery? / Erstad, Brian L.

In: European Spine Journal, Vol. 13, No. SUPPL. 1, 10.2004.

Research output: Contribution to journalArticle

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