No increase in blood transfusions during liver transplantation since the withdrawal of aprotinin.
The aims of this study were to determine whether the withdrawal of aprotinin (APRO) led to an increased bleeding risk in patients undergoing orthotopic liver transplantation (OLT). A retrospective analysis compared consecutive patients undergoing OLT and treated with aprotinin (APRO group; n = 100) with a group in which aprotinin was not used (no-APRO group; n = 100). Propensity score matching was then performed for each group to identify 2 matched cohorts. Patients were matched by their primary diagnoses and Model for End-Stage Liver Disease scores. This resulted in 2 matched cohorts with 55 patients in each group. None of the patients in the APRO group had significant fibrinolysis. In the no-APRO group, 23.6% of the patients developed fibrinolysis (P < 0.003). Tranexamic acid was used in 61.5% of the patients (n = 8) in the no-APRO group in whom lysis was present, and this resolved the fibrinolysis in all but 1 of these patients. There were no differences in red blood cell, fresh frozen plasma, platelet concentrate, or cryoprecipitate transfusions between the 2 groups. In conclusion, we have shown a significant increase in the prevalence of fibrinolysis during OLT since the withdrawal of APRO. However, there has been no increase in transfusion requirements.
Department of Anaesthesia, Royal Free Hospital, Hampstead, London, United Kingdom.
Nick
N
Schofield
Anita
A
Sugavanam
Karen
K
Thompson
Susan V
SV
Mallett
D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004548:Elasticity; D005260:Female; D005342:Fibrinolysis; D006470:Hemorrhage / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014148:Tranexamic Acid / Q000737:chemistry; D014783:Viscosity
D006490:Hemostatics; D014148:Tranexamic Acid; D007611:Aprotinin