TY - JOUR
T1 - Continuous Small-Dose Aprotinin Controls Fibrinolysis during Orthotopic Liver Transplantation
AU - Marcel, Randy J.
AU - Stegall, William C.
AU - Tracy Suit, C.
AU - Arnold, John C.
AU - Vera, Richard L.
AU - Ramsay, Michael A E
AU - O'Donnell, Michael B.
AU - Swygert, Thomas H.
AU - Tillmann Hein, H. A.
AU - Whitten, Charles W.
PY - 1996
Y1 - 1996
N2 - 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 μg/mL) at the end of surgery compared to the aprotinin group (53% > 20 μg/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.
AB - 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 μg/mL) at the end of surgery compared to the aprotinin group (53% > 20 μg/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.
UR - http://www.scopus.com/inward/record.url?scp=0029995641&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0029995641&partnerID=8YFLogxK
U2 - 10.1213/00000539-199606000-00004
DO - 10.1213/00000539-199606000-00004
M3 - Article
C2 - 8638778
AN - SCOPUS:0029995641
SN - 0003-2999
VL - 82
SP - 1122
EP - 1125
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 6
ER -