title: The prophylactic effect of aprotinin on intraoperative bleeding in liver transplantation: a randomized clinical study.
abstract: Fibrinolysis has been recognized as an important cause of intraoperative bleeding during orthotopic liver transplantation (OLT). Several investigators have used prophylactic administration of aprotinin in patients to inhibit fibrinolysis and to decrease transfusion requirements, morbidity, and mortality. Nevertheless, the role of aprotinin in this situation is not yet clear. The goal of this study was to determine the effects of prophylactic administration of aprotinin on intraoperative bleeding and blood requirements, and on hemostatic changes during OLT. Eighty consecutive patients were included in a double-blind, prospective study and were randomized in two groups. In group A (n = 39), an initial dose of 2 x 10(6) kallikrein inactivator units (KIU) of aprotinin was administered in the induction of anesthesia followed by infusion of 5 x 10(5) KIU/h until the end of the procedure. The control group (n = 41) received an identical volume of saline solution. The majority of the operations were performed with vena cava preservation (piggy-back technique) without venovenous bypass. During the anhepatic phase, a significant increase in levels of tissue plasminogen activator, thrombin-antithrombin complexes (TAT) and D-dimers (DD) was noted in both groups. A significant increment of TAT was observed in group A during reperfusion. The remaining hemostatic parameters were similar in both groups. Intraoperative requirements of packed red cells, fresh-frozen plasma (FFP), platelets, and cryoprecipitate were similar in the two groups. Our results suggest that prophylactic administration of aprotinin is not useful in reducing bleeding and blood product requirements during OLT.
authors.affiliation: Department of Anesthesiology, C.S.U. de Bellvitge, University of Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: García-Huete
authors.forename: P
authors.initials: P
authors.lastname: Domenech
authors.forename: A
authors.initials: A
authors.lastname: Sabaté
authors.forename: F
authors.initials: F
authors.lastname: Martínez-Brotons
authors.forename: E
authors.initials: E
authors.lastname: Jaurrieta
authors.forename: J
authors.initials: J
authors.lastname: Figueras
mesh_terms: D000293:Adolescent; D000328:Adult; D000990:Antithrombin III / Q000032:analysis; D007611:Aprotinin / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006470:Hemorrhage / Q000517:prevention & control*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis; D011446:Prospective Studies; D010959:Tissue Plasminogen Activator / Q000097:blood; D017211:Treatment Failure
chemical_list: D006490:Hemostatics; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D005340:Fibrinogen; D007611:Aprotinin; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator