Aprotinin in the Management of Coagulopathy Associated with Amniotic Fluid Embolus

Stroup, Jeffrey S.; Haraway, G. Davin; Beal, J. Martin

doi:10.1592/phco.26.5.689

Cited by 13 publications

(10 citation statements)

References 16 publications

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“…The use of tranexamic acid in the treatment of hyperfibrinolysis after amniotic fluid embolism has not yet been reported. After market withdrawal of aprotinin, a drug that has been reported to be effective in reducing hemorrhage after AFE [14], tranexamic acid is the therapeutic alternative substitute.…”

Section: Discussionmentioning

confidence: 99%

Algorithm-based coagulation management of catastrophic amniotic fluid embolism

Annecke

Geisenberger

Kürzl

et al. 2010

Blood Coagulation & Fibrinolysis

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Amniotic fluid embolism (AFE) is a rare, but often catastrophic, complication of pregnancy and associated with severe coagulopathy. We present an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE. Thrombelastometry was used for rapid evaluation of the coagulation status. Stop of extensive hyperfibrinolysis with tranexamic acid, stabilization of initial clot formation with high-dose fibrinogen and platelet transfusions, and use of prothrombin complex concentrate together with a 1: 1 transfusion regimen of red packed cells and fresh frozen plasma was successful to control diffuse bleeding and restore clot firmness after hysterectomy. Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient.

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Section: Discussionmentioning

confidence: 99%

Algorithm-based coagulation management of catastrophic amniotic fluid embolism

Annecke

Geisenberger

Kürzl

et al. 2010

Blood Coagulation & Fibrinolysis

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“…CS may be complicated by excess bleeding, requiring ligation of the uterine arteries and perhaps hysterectomy. There is no specific treatment, although both aprotinin and activated protein C, compounds that modulate inflammation and coagulation, may have some utility [18]. Critical care management should be directed at maintaining oxygen delivery and supporting the heart and circulation with inotropes and vasopressors.…”

Section: Amniotic Fluid Embolus Syndromementioning

confidence: 99%

Clinical review: Special populations - critical illness and pregnancy

Neligan

Laffey

2011

Critical Care

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Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.

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“…[6] Isolated case reports of successful management of AFE with other treatment modalities such as inhaled nitric oxide, inhaled prostacyclin, aprotinin, exchange transfusion, continuous hemodiafiltration, cell salvage, and pulmonary thromboembolectomy have been published. [45][46][47][48][49][50] The extent of their usefulness in AFE is uncertain.…”

Section: Laboratory Testsmentioning

confidence: 99%