The prophylactic effect of aprotinin on intraoperative bleeding in liver transplantation: A randomized clinical study

Abstract

Fibrinolysis has been recognized as an important cause of ogy of intraoperative hemorrhage is multifactorial. On the one hand, preoperative plaquetopenia is very common in intraoperative bleeding during orthotopic liver transplantation (OLT). Several investigators have used prophylactic ad-patients with end-stage liver disease; they also present an important deficit in coagulation and inhibitor factors as a ministration of aprotinin in patients to inhibit fibrinolysis and to decrease transfusion requirements, morbidity, and mortal-result of poor synthesis and clearance of these substances. 4 On the other hand, dilutional coagulopathy 5 can be a probity. Nevertheless, the role of aprotinin in this situation is not yet clear. The goal of this study was to determine the effects lem frequently encountered during the entire surgical procedure, 6 and fibrinolysis usually appears at the end of the anheof prophylactic administration of aprotinin on intraoperative bleeding and blood requirements, and on hemostatic changes patic phase and the beginning of the reperfusion of the graft. 7-9Therefore, there is a growing interest in the possible benefits during OLT. Eighty consecutive patients were included in a double-blind, prospective study and were randomized in two obtained in intraoperative bleeding with the use of prophylactic and therapeutic antifibrinolytic agents.10,11groups. In group A (n Å 39), an initial dose of 2 1 10 6 kallikrein inactivator units (KIU) of aprotinin was adminisAprotinin is a polypeptide with antifibrinolytic effects that has been reported to decrease operative bleeding in open tered in the induction of anesthesia followed by infusion of 5 1 10 5 KIU/h until the end of the procedure. The control heart surgery. [12][13][14][15] The benefits of aprotinin's prophylactic administration have also been studied in OLT to reduce intragroup (n Å 41) received an identical volume of saline solution. The majority of the operations were performed with vena operative bleeding. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] However, the majority of papers published until now have been nonrandomized retrospective cava preservation (piggy-back technique) without venovenous bypass. During the anhepatic phase, a significant increase in studies, or the number of patients included was too small for conclusions to be drawn. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Therefore, the exact role of levels of tissue plasminogen activator, thrombin-antithrombin complexes (TAT) and D-dimers (DD) was noted in both aprotinin in OLT has yet to be clearly determined.The purpose of this paper was to establish the value of groups. A significant increment of TAT was observed in group A during reperfusion. The remaining hemostatic parameters prophylactic administration of aprotinin in OLT in a prospective randomized double-blind study. Exclusion criteria were retransplantation within less than 3 months, multiorgan transplantation, and acute liver failure. A total Orthotopic liver transplantation (OLT...

Requirements for transfusion and postoperative outcomes in orthotopic liver transplantation: A meta-analysis on aprotinin

“…However, there are still some conflicting results on whether aprotinin can reduce blood loss or the requirement for transfusion in OLT [9,10] , and whether it can be beneficial to postoperative outcomes [11,12] . The objective of this systemic review was to study the effect of aprotinin used in OLT on the intraoperative requirement of blood products, and on the incidence of laparotomy for bleeding, thrombotic events and mortality.…”

“…Finally 7 citations [9,10,[13][14][15][16][17] , including 521 patients, were included in our study ( Figure 1). Of these 7 studies, one used tranexamic acid in the control group [16] ; two studies contained two aprotinin groups, a high dose group and a routine dose group [10,15] ; one study contained two control groups [17] ; and two studies used the same sample [10,15] , the size of which was calculated only once.…”

“…Four citations, including 321 procedures, contained results on the requirement for blood products including RBCs and fresh frozen plasma (FFP) [10,14,16,17] . One of these studies contained two control groups [17] (C1 and C2); Neither aprotinin nor any other antifibrinolytic agent was used in either group, so we just took C2 as the control group.…”

Cost and utilization of blood transfusion associated with spinal surgeries in the United States

“…Several possible methods of reducing blood loss and the need for ABT associated with spinal fusion surgery currently exist. These include use of autologous pre-donation of blood [7,11,16,26, 31, 32, 40], blood dilution techniques [4,10,14,15,19,22], erythropoietin [24], use of antifibrinolytics [1,8,9,20,24,27, 30, 34, 35, 41], and use of cell salvage [6, 33]. Prior research on techniques used to reduce the need for ABT has previously been conducted in single-site hospitals or in a small number of patients enrolled in a clinical trial, which does not accurately provide a clear picture of the utilization and cost burden associated with it.…”

What is the evidence for using hemostatic agents in surgery?

“…Of the larger studies involving hepatic resection or transplantation, two double-blinded RCTs (n=97 and n=137) involving aprotinin found statistically significant reductions in blood loss and transfusion requirements [20,28], and a third RCT with a somewhat smaller sample size (n=80) found trends toward benefits with aprotinin [11]. A fourth double-blinded RCT (n=132) comparing tranexamic acid and aminocaproic acid to placebo found reductions in transfusion requirements with both lysine analogues compared to placebo, but the results were only statistically significant for tranexamic acid [7].…”