The effect of aprotinin on blood loss in bilateral total knee arthroplasty.

Twenty-five patients undergoing bilateral total knee arthroplasty were given aprotinin (1-2 million units) in doses adjusted for weight, infused at the end of the first arthroplasty. Blood management was compared with our previous series of 68 patients who were not treated with aprotinin. Blood drained and re-transfused in the first 6 h was significantly less in the aprotinin group (323 ml, S.D. 320) than the untreated group (1033 ml, S.D. 539, p<0.0005). The total blood drained was also less in the aprotinin group (713 ml compared to 1613 ml, p<0.0005) but this was accounted for soley by the difference in early blood loss. The use of other blood products was less in the aprotinin group (360 ml, S.D. 357 compared to 827 ml, S.D. 434, p<0.0005). The mean postoperative haemoglobin on the day following surgery was similar at around 10 g. There were no complications or adverse reactions to the use of aprotinin. We conclude that aprotinin significantly reduces early blood loss after bilateral knee arthroplasty. In our hands, we have found it to be safe. Further work is required to determine whether postoperative use may further reduce the need for blood transfusion.