Aprotinin is a serine protease inhibitor used during surgery to constrain excess bleeding. Two previous studies on aprotinin have shown a reduction in blood loss during thoracic surgery and a decrease in the volume of blood needed for transfusions during surgery. The study being discussed here looked at the use of aprotinin during extrapleural pneumonectomy and inquired into post-operative complications from aprotinin's use.

An extrapleural pneumonectomy (EPP) is a very complex surgery used in the treatment of malignant pleural mesothelioma. During EPP, the lung and the affected pleural surface are removed, as are parts of the pericardium (the membrane covering the heart) and parts of the diaphragm (the muscle between the lungs and the abdomen). Due to its complexity, an EPP should only be performed by an experienced physician. Even then, an EPP is a very serious operation, so an agent or modality that can reduce possible complications, such as blood loss, would be helpful to the surgeon, as well as to the patient.

Description of Patients and Methods

The researchers who completed this study were physicians with the University of Texas MD Anderson Cancer Center, in Houston, TX. They conducted a retrospective study based on the hospital records of the 52 patients who had undergone an EPP at MD Anderson. 27 had received aprotinin and 25 had not. All patients treated had malignant pleural mesothelioma or another malignant pleural disease and all had similar workups and staging procedures. Data was compared on a variety of variables and special attention was paid to post-operative problems, especially problems with renal function or blood-clotting (thromboembolic) events.

Conclusion

The researchers concluded that aprotinin may be useful for EPP, but the attending doctor's decision should be based on the clinical facts at hand. Aprotinin's results on controlling blood loss were mixed: it significantly reduced the use of non-PRBC blood products and post-op chest tube output, but did not decrease interoperative blood loss or PRBC transfusions. More importantly though, use of aprotinin was not associated with an increase in adverse complications. Becuase of this, aprotinin is potentially useful for both surgeon and patient.

Labels: mesothelioma