Aminocaproic acid (Amicar) as an alternative to aprotinin (Trasylol) in liver transplantation

R. S. Mangus, S. B. Kinsella, J. A. Fridell, C. A. Kubal, P. Lahsaei, L. O. Mark, A. J. Tector

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction This study compared clinical outcomes for a large number of liver transplant patients receiving intraoperative epsilon-aminocaproic acid (EACA), aprotinin, or no antifibrinolytic agent over an 8-year period. Patients and Methods Records for deceased donor liver transplants were reviewed. Data included antifibrinolytic agent, blood loss, early graft function, and postoperative complications. Study groups included low-dose aprotinin, high-dose aprotinin, EACA (25 mg/kg, 1-hour infusion), or no antifibrinolytic agent. Results Data were included for 1170 consecutive transplants. Groups included low-dose aprotinin (n = 324 [28%]), high-dose aprotinin (n = 308 [26%]), EACA (n = 216 [18%]), or no antifibrinolytic (n = 322 [28%]). EACA had the lowest intraoperative blood loss and required the fewest transfusions of plasma. Patients receiving no agent required the most blood transfusions. Early graft loss was lowest in the EACA group, and 90-day and 1-year patient survival rates were significantly higher for the low-dose aprotinin and EACA groups according to Cox regression. Complications were similar, but there were more episodes of deep vein thrombosis in patients receiving EACA. Conclusions These results suggest that transitioning from aprotinin to EACA did not result in worse outcomes. In addition to decreased intraoperative blood loss, a trend toward improved graft and patient survival was seen in patients receiving EACA.

Original languageEnglish (US)
Pages (from-to)1393-1399
Number of pages7
JournalTransplantation Proceedings
Volume46
Issue number5
DOIs
StatePublished - Jan 1 2014

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Aminocaproic Acid
Aprotinin
Liver Transplantation
Antifibrinolytic Agents
Transplants
Liver
Graft Survival
Venous Thrombosis
Blood Transfusion
Survival Rate
Tissue Donors

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Medicine(all)

Cite this

Aminocaproic acid (Amicar) as an alternative to aprotinin (Trasylol) in liver transplantation. / Mangus, R. S.; Kinsella, S. B.; Fridell, J. A.; Kubal, C. A.; Lahsaei, P.; Mark, L. O.; Tector, A. J.

In: Transplantation Proceedings, Vol. 46, No. 5, 01.01.2014, p. 1393-1399.

Research output: Contribution to journalArticle

Mangus, R. S. ; Kinsella, S. B. ; Fridell, J. A. ; Kubal, C. A. ; Lahsaei, P. ; Mark, L. O. ; Tector, A. J. / Aminocaproic acid (Amicar) as an alternative to aprotinin (Trasylol) in liver transplantation. In: Transplantation Proceedings. 2014 ; Vol. 46, No. 5. pp. 1393-1399.
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abstract = "Introduction This study compared clinical outcomes for a large number of liver transplant patients receiving intraoperative epsilon-aminocaproic acid (EACA), aprotinin, or no antifibrinolytic agent over an 8-year period. Patients and Methods Records for deceased donor liver transplants were reviewed. Data included antifibrinolytic agent, blood loss, early graft function, and postoperative complications. Study groups included low-dose aprotinin, high-dose aprotinin, EACA (25 mg/kg, 1-hour infusion), or no antifibrinolytic agent. Results Data were included for 1170 consecutive transplants. Groups included low-dose aprotinin (n = 324 [28{\%}]), high-dose aprotinin (n = 308 [26{\%}]), EACA (n = 216 [18{\%}]), or no antifibrinolytic (n = 322 [28{\%}]). EACA had the lowest intraoperative blood loss and required the fewest transfusions of plasma. Patients receiving no agent required the most blood transfusions. Early graft loss was lowest in the EACA group, and 90-day and 1-year patient survival rates were significantly higher for the low-dose aprotinin and EACA groups according to Cox regression. Complications were similar, but there were more episodes of deep vein thrombosis in patients receiving EACA. Conclusions These results suggest that transitioning from aprotinin to EACA did not result in worse outcomes. In addition to decreased intraoperative blood loss, a trend toward improved graft and patient survival was seen in patients receiving EACA.",
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