THE INTRAOPERATIVE USE OF TRASYLOL (APROTININ) IN LIVER-TRANSPLANTATION

被引：26

作者：

MALLETT, SV ^{[1
]}

COX, D ^{[1
]}

BURROUGHS, AK ^{[1
]}

ROLLES, K ^{[1
]}

机构：

[1] ROYAL FREE HOSP,SCH MED,DEPT ANAESTHESIA,POND ST,LONDON NW3 2QG,ENGLAND

来源：

TRANSPLANT INTERNATIONAL | 1991年 / 4卷 / 04期

关键词：

LIVER TRANSPLANTATION; TRASYLOL; APROTININ;

D O I：

10.1007/BF00649108

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Aprotinin has been reported to reduce blood loss in difficult cases requiring cardiopulmonary bypass surgery and more recently in liver transplantation. Over a 9-month period we compared the effects of an intra-operative infusion of aprotinin on transfusion requirements and coagulation profiles in 12 patients undergoing liver transplantation for end-stage cirrhosis with an equal number of consecutive transplants in patients with similar pathology who did not receive aprotinin. Transfusion of blood and blood products was reduced to one-third in the aprotinin-treated group. Operative time was also significantly reduced, as was ICU stay post-operatively. Aprotinin profoundly inhibits fibrinolysis and this is likely to be the major effect by which blood loss is reduced. Thromboelastography revealed severe fibrinolytic changes in the anhepatic stage in 4 of 6 controlled patients; this accelerated in 3 following reperfusion of the new graft. By contrast, only 1 patient of 12 in the aprotinin-treated group showed fibrinolytic activity in the anhepatic period, and none showed evidence of fibrinolysis following reperfusion of the new graft.

引用

页码：227 / 230

页数：4

共 7 条

[1]

Fletcher A.P., Biederman O., Moore D., Alkjaersig N., Sherry S., Abnormal plasminogen-plasmin system activity (fibrinolysis) in patients with hepatic cirrhosis, J Clin Invest, 43, pp. 681-695, (1964)

[2]

Hunt B.J., Cottam S., Segal H., Ginsburg R., Potter D., Inhibition by Aprotinin of tPA — mediated fibrinolysis during orthotopic liver transplantation, Lancet, 1, pp. 336-381, (1990)

[3]

Kang Y., Lewis J.H., Navalgund A., Russell M.W., Bontempo F.A., Niren L.S., Starzl T.E., Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation, Anesthesiology, 66, pp. 766-773, (1987)

[4]

Neuhaus P., Bechstein W.O., Lefebre O., Blumhardt G., Slama K., Effect of Aprotinin on intraoperative bleeding and fibrinolysis in liver transplantation, Lancet, 2, pp. 924-925, (1989)

[5]

Porte R.J., Bontempo F.A., Knott E.A.R., Systemic effects of tissue plasminogen activator associated fibrinolysis and its relation to thrombin generation in orthotopic liver transplantation, Transplantation, 47, pp. 978-984, (1989)

[6]

Royston D., Taylor K.M., Bidstrup B.P., Sapsford R.N., Effect of Aprotinin on the need for blood transfusions after repeat open heart surgery, Lancet, 1, pp. 1289-1291, (1987)

[7]

Tice D.A., Worth M.H., Clauss R.H., Reed G.H., The inhibition by Trasylol of fibrinolytic activity associated with cardiovascular operations, Surg Gynecol Obstet, 119, pp. 71-74, (1964)

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