Aprotinin significantly decreases transfusion rates in extrapleural pneumonectomy

INTRODUCTION: Aprotinin (TrasylolTM Bayer Corporation, West Haven, CT) is a serine protease inhibitor, which inhibits all serine proteases including plasmin. It has been used to significantly decrease blood loss during repeat cardiac surgery utilizing cardiopulmonary bypass and is currently the only pharmacologic agent approved by the FDA for this purpose. The operation of extrapleural pneumonectomy (EPP), done almost exclusively for mesothelioma, is associated with the potential for significant blood loss due to the large raw surface of the hemithorax left behind after resection of the parietal pleura. We investigated whether aprotinin would decrease blood loss and transfusion requirement in this major operation.