Total hip arthroplasty surgery may be associated with substantial loss of blood often necessitating blood transfusion.

The risks associated with blood transfusions are widely known. Haemostatic drugs have been tried in the past to try and reduce this, and there has been renewed interest in these recently, in particular Aprotinin (Bayer).

Aprotinin is a serine protease inhibitor, which has been shown to reduce blood loss in cardiac surgery by up to eighty percent.

The aim of our study was to investigate whether or not high dose Aprotinin can reduce blood loss and transfusion rates in patients’ undergoing total hip arthroplasty.

This was a randomised double blind controlled clinical trial, where 50 patients were randomised to receive either Aprotinin (2 x 106 KIU followed by an infusion of 5 x 105 KIU/hr), or an equivalent volume of normal saline.

Blood loss and transfusion rates were measured as well as the incidence of deep vein thrombosis.

There was a significant reduction in total blood loss seen in the Aprotinin group, median 817±350, when compared to the control group, median 1191±386. This translates to a 31% reduction in blood loss.

DVT and transfusion rates were not significantly different between the two groups.

There was no complications or deaths seen in the Aprotinin group.

The use of high dose Aprotinin results in a reduction in blood loss in total hip arthroplasty. It has been proved to reduce blood loss in cardiac surgery, and although papers have shown it can reduce blood loss in orthopaedic surgery, its’ use should not as yet be routine.

Further work is required to investigate the possibility of a future role for Aprotinin in orthopaedic surgery, as well as its’ mode of action. Until then more established methods of blood conservation should be used.