Antifibrinolytics in orthotopic liver transplantation: current status and controversies.
This article reviews the current status and controversies of the 3 commonly used antifibrinolytics-epsilon-aminocaproic acid, tranexamic acid and aprotinin-during liver transplantation. There is no general consensus on how, when or which antifibrinolytics should be used in liver transplantation. Although these drugs appear to reduce blood loss and decrease transfusion requirements during liver transplantation, their use is not supported uniformly in clinical trials. Aprotinin has been studied more extensively in clinical trials and appear to offer more advantages compared to two other antifibrinolytics. Because of the diverse population of liver transplant recipients and the potential adverse effects of antifibrinolytics, especially life-threatening thromboembolism, careful patient selection and close monitoring is prudent. Further studies addressing the risks and benefits of antifibrinolytics in the setting of liver transplantation are warranted.
Xia
Victor W
VW
Department of Anesthesiology, Liver Transplant Service, David Geffen School of Medicine, University of California, Box 951778, Los Angeles, Los Angeles, CA 90095, USA. vxia@mednet.ucla.edu
Steadman
Randolph H
RH
D015119:Aminocaproic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D016031:Liver Transplantation; D013923:Thromboembolism / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000009:adverse effects
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin; D015119:Aminocaproic Acid