Medical haemostasis in acute hepatocyte injury and experimental liver trauma.
BACKGROUND
The aim of the present study was to test the effectiveness of aprotinin to reduce bleeding in liver resection of guinea pigs with acutely injured hepatocyte using intraperitoneal d(+)Galactosamine.


METHODS
Thirty-two guinea pigs were divided equally into four groups. Group 1 was the control group. Group 2 received intraperitoneal D(+)galactosamine. Group 3 received intraperitoneal d(+)galactosamine prior to a standard liver resection. Group 4 received 10.000 KIU/kg aprotinin infusion via jugular catheter in 10 min prior to standard liver resection in pretreated animals with d(+)galactosamine. All of the measurements and surgical interventions were made 24 h after the administration of d(+)galactosamine. Bleeding amounts were recorded in groups 3 and 4 for 1 h by weighing the sponges placed into the abdomen. Liver function tests, histologic, haematologic and fibrinolytic parameters were measured.


RESULTS
Hepatocyte injury and hyperfibrinolysis were seen at the end of 24 h after application of d(+)galactosamine in groups 2, 3, and 4. Statistically significant amounts of bleeding from the resected livers were observed in group 3 and 4. In group 4, the bleeding was reduced (P < 0.05) and fibrinolytic parameters were normalized (P < 0.05) with aprotinin infusion.


CONCLUSIONS
Significant bleeding diathesis and hyperfibrinolysis occurred in groups 2, 3, and 4, which had hepatocyte injury proved with histopathologic and haematologic tests. Prothrombin time (PT) and partial thromboplastin time (aPTT) in groups 3 and 4 were fivefold higher than that in the control group (P = 0.0001). The bleeding tendency according to high PT and aPTT levels were continued with application of aprotinin while reduction of bleeding was seen. Parenchymatous organ haemorrhage in acute liver failure or hyperfibrinolytic conditions could be reduced significantly with aprotinin without procoagulant effect.
Cihan
Alper
A
Department of Surgery, Medical Faculty of Zonguldak Karaelmas University, Turkey. acihan@karaelmas.edu.tr
Yilmaz
Erdal
E
Yenidünya
Sibel
S
Uçan
Bülent H
BH
D000818:Animals; D007611:Aprotinin / Q000494:pharmacology / Q000627:therapeutic use*; D001779:Blood Coagulation Factors / Q000187:drug effects / Q000378:metabolism; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D004195:Disease Models, Animal; D005342:Fibrinolysis / Q000187:drug effects*; D005688:Galactosamine; D006168:Guinea Pigs; D006474:Hemorrhagic Disorders / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D006490:Hemostatics / Q000494:pharmacology / Q000627:therapeutic use*; D006498:Hepatectomy / Q000009:adverse effects; D022781:Hepatocytes / Q000473:pathology; D008099:Liver / Q000293:injuries / Q000473:pathology
D001779:Blood Coagulation Factors; D006490:Hemostatics; D005688:Galactosamine; D007611:Aprotinin