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Aprotinin in orthotopic liver transplantation: Evidence for a prohemostatic, but not a prothrombotic, effect
Author(s) -
Molenaar I. Quintus,
Legnani Cristina,
Groenland Theo H.N.,
Palareti Gualtiero,
Begliomini Bruno,
Terpstra Onno T.,
Porte Robert J.
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.27854
Subject(s) - aprotinin , medicine , partial thromboplastin time , fibrinolysis , prothrombin time , thromboelastography , anesthesia , liver transplantation , antifibrinolytic , placebo , gastroenterology , plasminogen activator , population , coagulation , antithrombin , transplantation , surgery , tranexamic acid , heparin , blood loss , pathology , alternative medicine , environmental health
Aprotinin reduces blood transfusion requirements in orthotopic liver transplantation (OLT). Concern has been voiced about the potential risk for thrombotic complications when aprotinin is used. The aim of this study is to evaluate the effects of aprotinin on the two components of the hemostatic system (coagulation and fibrinolysis) in patients undergoing OLT. As part of a larger, randomized, double‐blind, placebo‐controlled study, we compared coagulation (fibrinogen level, activated partial thromboplastin time [aPTT], prothrombin time, and platelet count) and fibrinolytic variables (tissue‐type plasminogen activator [tPA] antigen and activity, plasminogen activator inhibitor activity, and D‐dimer), as well as thromboelastography (reaction time [r], clot formation time, and maximum amplitude) in 27 patients administered either high‐dose aprotinin (2 × 10 6 kallikrein inhibitor units [KIU] at induction, continuous infusion of 1 × 10 6 KIU/h, and 1 × 10 6 KIU before reperfusion; n = 10), regular‐dose aprotinin (2 × 10 6 KIU at induction and continuous infusion of 0.5 × 10 6 KIU/h; n = 8), or placebo (n = 9) during OLT. Blood samples were drawn at seven standardized intraoperative times. Baseline characteristics were similar for the three groups. During the anhepatic and postreperfusion periods, fibrinolytic activity (plasma D‐dimer and tPA antigen levels) was significantly lower in aprotinin‐treated patients compared with the placebo group. Interestingly, coagulation times (aPTT and r) were significantly more prolonged in aprotinin‐treated patients than the placebo group. No difference was seen in the incidence of perioperative thrombotic complications in the entire study population (n = 137). Aprotinin has an anticoagulant rather than a procoagulant effect. Its blood‐sparing (prohemostatic) effect appears to be the overall result of a strong antifibrinolytic and a weaker anticoagulant effect. These findings argue against a prothrombotic effect of aprotinin in patients undergoing OLT.