Continuous Small-Dose Aprotinin Controls Fibrinolysis during Orthotopic Liver Transplantation

Randy J. Marcel, William C. Stegall, C. Tracy Suit, John C. Arnold, Richard L. Vera, Michael A E Ramsay, Michael B. O'Donnell, Thomas H. Swygert, H. A. Tillmann Hein, Charles W. Whitten

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1122-1125
Number of pages4
JournalAnesthesia and Analgesia
Volume82
Issue number6
Publication statusPublished - 1996

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ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Marcel, R. J., Stegall, W. C., Tracy Suit, C., Arnold, J. C., Vera, R. L., Ramsay, M. A. E., ... Whitten, C. W. (1996). Continuous Small-Dose Aprotinin Controls Fibrinolysis during Orthotopic Liver Transplantation. Anesthesia and Analgesia, 82(6), 1122-1125.