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Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation

Kang, Y and Lewis, JH and Navalgund, A and Russell, MW and Bontempo, FA and Niren, LS and Starzl, TE (1987) Epsilon-aminocaproic acid for treatment of fibrinolysis during liver transplantation. Anesthesiology, 66 (6). 766 - 773. ISSN 0003-3022

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Abstract

In 97 adult patients receiving liver transplants, the coagulation system was monitored by thrombelastography and by coagulation profile including PT; a PTT; platelet count; level of factors I, II, V, VII, VIII, IX, X, XI, and XII; fibrin degradation products; ethanol gel test; protamine gel test; and euglobulin lysis time. Preoperatively, fibrinolysis defined as a whole blood clot lysis index of less than 80% was present in 29 patients (29.9%), and a euglobulin lysis time of less than 1 h was present in 13 patients. Fibrinolysis increased progressively during surgery in 80 patients (82.5%) and was most severe on reperfusion of the graft liver in 33 patients (34%). When whole blood clot lysis (F < 180 min) was observed during reperfusion of the graft liver, blood coagulability was tested by thrombelastography using both a blood sample treated in vitro with ε-aminocaproic acid (0.09%) and an untreated sample. Blood treated with ε-aminocaproic acid showed improved coagulation without fibrinolytic activity in all 74 tests. When whole blood clot lysis time was less than 120 min, generalized oozing occurred, and the effectiveness of ε-aminocaproic acid was demonstrated in vitro during the pre-anhepatic and post-anhepatic stages, ε-aminocaproic acid (1 g, single intravenous dose) was administered. In all 20 patients treated with ε-aminocaproic acid, fibrinolytic activity disappeared; whole blood clot lysis was not seen on thrombelastography during a 5-h observation period, and whole blood clot lysis index improved from 28.5 ± 29.5% to 94.8 ± 7.4% (mean ± SD, P < 0.001). None of the treated patients had hemorrhagic or thrombotic complications. In patients undergoing liver transplantation, the judicious use of a small dose of ε-aminocaproic acid, when its efficacy was confirmed in vitro, effectively treated the severe fibrinolysis without clinical thrombotic complications.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kang, Y
Lewis, JH
Navalgund, A
Russell, MW
Bontempo, FA
Niren, LS
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 17 August 1987
Date Type: Publication
Journal or Publication Title: Anesthesiology
Volume: 66
Number: 6
Page Range: 766 - 773
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0003-3022
Other ID: uls-drl:31735062118892, Starzl CV No. 696
Date Deposited: 08 Apr 2010 17:11
Last Modified: 05 Feb 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/4082

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