Aprotinin is a serine protease inhibitor with antifibrinolytic properties
that has been approved as a blood-conserving drug in cardiac surgery by the
United States Food and Drug Administration.
On the basis of the current evidence from Level-I trials, we make a grade-A
recommendation for use of the high-dose aprotinin regimen in hip and spine
surgery.
Because of conflicting data, the low-dose aprotinin therapy as well as the
use of aprotinin in patients with cancer cannot be recommended (grade-I
recommendation).
High-quality randomized trials are necessary to determine the optimal (and
minimal) therapeutic dose of aprotinin and the optimal time of aprotinin
administration during surgery.