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Evidence-Based Review of the Role of Aprotinin in Blood Conservation During Orthopaedic Surgery
Agnieszka Kokoszka, MD1; Paul Kuflik, MD2; Fabien Bitan, MD2; Andrew Casden, MD2; Michael Neuwirth, MD2
1 Department of Neurology, SVCMC'St. Vincent's Hospital Manhattan, 153 West 11th Street, Cronin 4, New York, NY 10011. E-mail address: agnieszka.kokoszka@mail.hsc.sunysb.edu
2 The Spine Institute, Beth Israel Medical Center, Phillips Ambulatory Care Center, 10 Union Square East, Suite 5P, New York, NY 10003
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Spine Institute, Beth Israel Medical Center, New York, NY

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 May 01;87(5):1129-1136. doi: 10.2106/JBJS.D.02240
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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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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