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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Item Type: |
Article
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Status: |
Published |
Creators/Authors: |
Creators | Email | Pitt Username | ORCID  |
---|
Kang, Y | | | | Lewis, JH | | | | Navalgund, A | | | | Russell, MW | | | | Bontempo, FA | | | | Niren, LS | | | | Starzl, TE | tes11@pitt.edu | TES11 | |
|
Centers: |
Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute |
Date: |
1 January 1987 |
Date Type: |
Publication |
Journal or Publication Title: |
Anesthesiology |
Volume: |
66 |
Number: |
6 |
Page Range: |
766 - 773 |
DOI or Unique Handle: |
10.1097/00000542-198706000-00010 |
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: |
04 Aug 2020 13:55 |
URI: |
http://d-scholarship.pitt.edu/id/eprint/4082 |
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