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The risk associated with aprotinin in cardiac surgery.

To read the commentary by Dean A. Fergusson, MHA, PhD, from the University of Ottawa Centre for Transfusion Research, please click here. See also the comment by Robert J. Porte, MD, PhD, Department of Surgery, Section Hepatobiliary Surgery and Liver Transplantation, and Herman G.D. Hendriks, MD, PhD, Department of Anesthesiology, University Medical Center Groningen, The […]

Heparin-level-based anticoagulation management during cardiopulmonary bypass: a pilot investigation on the effects of a half-dose aprotinin protocol on postoperative blood loss and hemostatic activation and inflammatory response.

Koster et al describe the use of a half-dose aprotinin protocol and the influence on postoperative blood loss. The second endpoint of this investigation was a bunch of several hemostatic and inflammatory markers. The authors claim to apply a new heparin-level-based anticoagulation management. Not surprisingly, the authors found a significant reduction of postop bleeding tendency. […]

An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery.

The recommended measures to reduce the use of blood transfusions are certainly right and one can recommend to follow the proposals. However, the excellent results of small trials investigated by the authors and the historical comparisons are surprising, and without further details excluding any bias, etc., the results are difficult to understand. Volker Kretschmer