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What is the evidence for using hemostatic agents in surgery?

  • Conference paper
Haemostasis in Spine Surgery

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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 doubleblinded 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.

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Author information

Authors and Affiliations

  1. Department of Pharmacy Practice and Science, College of Pharmacy, Tucson, Arizona, 85721-0207, USA

    Brian L. Erstad

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  1. Brian L. Erstad
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Editor information

Editors and Affiliations

  1. Iris South Teaching Hospitals, 142 Rue Marconi, 1190, Brussels, Belgium

    Marek Szpalski

  2. Dept. of Anesthesia & Staff Cardiovascular Research Inst., University of California, 94143-0648, San Francisco, USA

    Richard B. Weiskopf

  3. Centenary Clinic, Harmoniestraat 68, 2018, Antwerp, Belgium

    Robert Gunzburg

  4. Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Stauffacherstr. 78, 3014, Bern, Switzerland

    Max Aebi

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© 2005 Springer-Verlag Berlin Heidelberg

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Erstad, B.L. (2005). What is the evidence for using hemostatic agents in surgery?. In: Szpalski, M., Weiskopf, R.B., Gunzburg, R., Aebi, M. (eds) Haemostasis in Spine Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27394-8_5

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  • DOI: https://doi.org/10.1007/3-540-27394-8_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-24234-5

  • Online ISBN: 978-3-540-27394-3

  • eBook Packages: MedicineMedicine (R0)

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