Aprotinin in orthotopic liver transplantation (OLT) : Clinical and economical interest in blood requirements

Lassale, B.; Rathelot, P.; Angelini, B.; Bongrand, M.C.; Timon-David, P.

Journal de Pharmacie Clinique 15(3): 187-191


ISSN/ISBN: 0291-1981
Accession: 008184267

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In order to reduce blood loss and homologous transfusions in orthotopic liver transplantation (OLT), the medical team have been associated with the intra-operative autologous blood transfusion to their surgical procedure since 1988. Then the patients have been given an antifibrinolytic drug: aprotinin. The administration of that drug at high doses may result in thrombotic events. Therefore, we compared the effect of low (100,000 KIU/hour) and high doses (leading dose of 2,000,000 KIU/hour after anesthesia induction, followed by a continuous infusion of 500,000 KIU/hour until the end of procedure of aprotinin (Antagosan) when combined with intra-operative blood salvage during OLT. The economic consequence of intra-operative autologous blood transfusion was similar in both groups of patients and made it possible to reach a 25% decrease of the expenses in pocked red blood cells (RBCs). Compared with the low dosage regimen, the administration of Antagosan at high doses resulted in a reduction of blood requirements in RBCs (p = 0.01) and fresh frozen plasma (FFP) (p = 0.01). No thrombotic event was noticed in either group. A total average saving of 2,883 F per patient on the transfusion-related-expenses (32%) was achieved thanks to this reduction of homologous blood transfusion. The obvious clinical interest and cost-effectiveness value of the aprotinin when administered at high doses in OLT couldn't be denied. Therefore this dosage regimen has been adopted.