Continuous small-dose aprotinin controls fibrinolysis during orthotopic liver transplantation.
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.
Marcel
R J
RJ
Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas, USA.
Stegall
W C
WC
Suit
C T
CT
Arnold
J C
JC
Vera
R L
RL
Ramsay
M A
MA
O'Donnell
M B
MB
Swygert
T H
TH
Hein
H A
HA
Whitten
C W
CW
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
D006490:Hemostatics; D010919:Placebos; D007611:Aprotinin