Aprotinin in spine surgery: review of the literature.

Based on a literature review, this article evaluates the efficacy of aprotinin to limit blood transfusion during spine surgery. Most prospective studies confirm this effect. However, broader studies are required to evaluate adverse effects. Severe complications are rarely, if ever, reported. Given the small size of most samples, complications are expected because of the widespread use of the drug. The cost of the medication has to be balanced with the cost of blood transfusion. A careful use of aprotinin allows a surgeon dealing with high-risk patients to avoid or limit the use of transfusions. For patients who are not high-risk, aprotinin should be avoided until other questions are answered.