title: Continuous small-dose aprotinin controls fibrinolysis during orthotopic liver transplantation.
abstract: Large doses of aprotinin (1,000,000-2,000,000 kallikrein inhibitor units [KIU] initial dose and a 500,000 KIU/h infusion) have been used during orthotopic liver transplantation (OLT) to reduce the incidence and severity of fibrinolysis. This double-blinded study was designed to investigate whether a small-dose infusion of aprotinin (200,000 KIU/h) would control fibrinolysis. A controlled study was undertaken to compare small-dose aprotinin with a placebo in patients undergoing OLT with veno-venous bypass. Forty-four patients were randomized either to the aprotinin group (n = 21), which received an intravenous infusion of 200,000 KIU/h without an initial dose, or to a control group (n = 23), which received normal saline. Coagulation variables, thrombelastograms, and postoperative blood drainage were measured. Blood levels of fibrin degradation products (FDP) were significantly higher in the control group (95% > 20 micrograms/mL) at the end of surgery compared to the aprotinin group (53% > 20 micrograms/mL, P < 0.01). The transfusion of cryoprecipitate units was more in the control group versus the aprotinin (12.6 +/- 12.8 vs 5.7 +/- 7.5; P < 0.04), as was the number of fresh frozen plasma units (6.6 +/- 3.5 vs 3.6 +/- 6.1; P < 0.05). We conclude that an infusion of a small dose of aprotinin can safely control fibrinolysis during liver transplantation with a concomitant reduction in transfusion of blood products.
authors.affiliation: Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Marcel
authors.forename: W C
authors.initials: WC
authors.lastname: Stegall
authors.forename: C T
authors.initials: CT
authors.lastname: Suit
authors.forename: J C
authors.initials: JC
authors.lastname: Arnold
authors.forename: R L
authors.initials: RL
authors.lastname: Vera
authors.forename: M A
authors.initials: MA
authors.lastname: Ramsay
authors.forename: M B
authors.initials: MB
authors.lastname: O'Donnell
authors.forename: T H
authors.initials: TH
authors.lastname: Swygert
authors.forename: H A
authors.initials: HA
authors.lastname: Hein
authors.forename: C W
authors.initials: CW
authors.lastname: Whitten
mesh_terms: D000758:Anesthesia / Q000379:methods; D007611:Aprotinin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005342:Fibrinolysis / Q000187:drug effects*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008099:Liver / Q000201:enzymology / Q000502:physiology; D016031:Liver Transplantation; D010314:Partial Thromboplastin Time; D010919:Placebos; D011446:Prospective Studies; D011517:Prothrombin Time
chemical_list: D006490:Hemostatics; D010919:Placebos; D007611:Aprotinin