Background Intraoperative hyperfibrinolysis contributes to bleeding during adult orthotopic liver transplantation. We aimed to find out whether aprotinin, a potent antifibrinolytic agent, reduces blood loss and transfusion requirements. Methods We did a randomised, double-blind, placebo- controlled trial in which six liver-transplant centres participated. Patients undergoing primary liver trans- plantation were randomly assigned intraoperative high-dose aprotinin, regular-dose aprotinin, or placebo. Primary endpoints were intraoperative blood loss and transfusion requirements. Secondary endpoints were perioperative fluid requirements, postoperative blood transfusions, complications, and mortality. Findings 137 patients received high-dose aprotinin (n=46), regular-dose aprotinin (n=43), or placebo (n=48). Intraoperative blood loss was significantly lower in the aprotinin-treated patients, with a reduction of 60% in the high-dose group and 44% in the regular-dose group, compared with the placebo group (p=0·03). Total amount of red blood cell (homologous and autologous) transfusion requirements was 37% lower in the high-dose group and 20% lower in the regular-dose group, than in the placebo group (p=0·02). Thromboembolic events occurred in two patients in the high-dose group, none in the regular-dose group, and in two patients in the placebo group (p=0·39). Mortality at 30 days did not differ between the three groups (6·5%, 4·7%, and 8·3%; p=0·79). Interpretation Intraoperative use of aprotinin in adult patients undergoing orthotopic liver transplantation significantly reduces blood-transfusion requirements and should be routinely used in patients without contraindications.
Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study / Robert J., Port; I., Quintus Molenaar; Begliomini, Bruno; Theo HN, Groenland; Anna, Januszkiewicz; Leena, Lindgren; Gualtiero, Palareti; Jo, Hermans; Onno T., Terpstra. - In: THE LANCET. - ISSN 0140-6736. - STAMPA. - 355(2000), pp. 1303-1309.
Data di pubblicazione: | 2000 |
Titolo: | Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study |
Autore/i: | Robert J., Port; I., Quintus Molenaar; Begliomini, Bruno; Theo HN, Groenland; Anna, Januszkiewicz; Leena, Lindgren; Gualtiero, Palareti; Jo, Hermans; Onno T., Terpstra |
Autore/i UNIMORE: | |
Digital Object Identifier (DOI): | http://dx.doi.org/10.1016/S0140-6736(00)02111-5 |
Rivista: | |
Volume: | 355 |
Pagina iniziale: | 1303 |
Pagina finale: | 1309 |
Codice identificativo ISI: | WOS:000086829400009 |
Codice identificativo Scopus: | 2-s2.0-0034655629 |
Codice identificativo Pubmed: | 10776742 |
Citazione: | Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study / Robert J., Port; I., Quintus Molenaar; Begliomini, Bruno; Theo HN, Groenland; Anna, Januszkiewicz; Leena, Lindgren; Gualtiero, Palareti; Jo, Hermans; Onno T., Terpstra. - In: THE LANCET. - ISSN 0140-6736. - STAMPA. - 355(2000), pp. 1303-1309. |
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