Aprotinin versus tranexamic acid in cirrhotic patients undergoing hepatic surgery

ABSTRACT

Patients with liver cirrhosis have complex hemostatic dysfunction characterized by impaired clotting factor synthesis, thrombocytopenia and accelerated fibrinolysis. Pharmacological management has been advocated to decrease bleeding and transfusions during major hepatic surgery, with the use of either aprotinin or tranexamic acid. In the present study, aprotinin was given in moderate doses to 10 patients and tranexmaic acid was given to another 10 patients compared with control group. Hemostasis was significantly better preserved after aprotinin treatment [blood loss of 373 ml in the aprotinin group, 524 ml in tranexamic acid group versus 956 ml in the control group]. Platelets were better preserved in aprotinin and tranexamic acid groups. Fibrinolysis was significantly reduced in aprotinin and tranexamic acid groups, where fibrinogen level was significantly reduced in the control group [206.8 mg/dl, 184 mg/dl at 4 and 6 hours intraoperatively] and FDPs were significantly increased in the control group [FDPs changed from 4.8 micro g/dl to 26 micro g/dl during surgery]. We conclude that prophylactic use of either aprotinin [in moderate doses] or tranexamic acid is equivocal and is mandatory in the operative management of hepatic resection