Comparative study of antifibrinolytic drugs in orthotopic liver transplantation

Dalmau, A.; Sabaté, A.; Acosta, Fernando; García-Huete, Lucía; Koo, Maylin; Reche, M; Rafecas, Antoni; Figueras, Joan; Jaurrieta, Eduardo

doi:10.1016/s0041-1345(99)00378-4

Cited by 18 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Epsilon-aminocaproic acid (EACA) and placebo were delivered to the operating room in numbered, but otherwise identical vials labelled “study drug”Participants40 patients undergoing first-time coronary artery bypass grafting without prior sternotomy were randomised to one of two groups: Epsilon aminocaproic acid group: n = 21, M/F 14/7, mean (sd) age = 63 (9) yearsControl group (Placebo): n = 19, M/F = 18/1, mean (sd) age = 67 (10) years Interventions Epsilon aminocaproic acid group (EACA) received 10g of EACA in 40ml of saline solution given after induction of anaesthesia but before the skin incision. Another 40ml was given after heparin administration in the pump, and a third 40ml dose was given after the administration of protamine.Control group (Placebo) received equivalent volumes of saline solution. NB: Both groups were exposed to cell salvage.Outcomes Outcomes reported: Number of patients exposed to allogeneic blood, blood loss (12/24hrs), myocardial infarction, stroke (cerebrovascular accident), use of shed mediastinal bloodNotesQuality assessment score (Schulz criteria): 6/7Transfusion protocol used Risk of bias Item Authors’ judgement Description Adequate sequence generation?UnclearUnclearAllocation concealment?YesAdequateBlinding?All outcomesYesDouble blind Dalmau 1999…”

Section: Characteristics Of Included Studies [Ordered By Study Id]mentioning

confidence: 99%

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Henry

Carless

Moxey

et al. 2011

Cochrane Database of Systematic Reviews

535

440

View full text Add to dashboard Cite

Section: Characteristics Of Included Studies [Ordered By Study Id]mentioning

confidence: 99%

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Henry

Carless

Moxey

et al. 2011

Cochrane Database of Systematic Reviews

535

440

View full text Add to dashboard Cite

“…In this report, 42 liver transplant patients received EACA (6 mg/hr), and 40 did not. EACA reduced transfusion requirements but not significantly 6. Taken together, EACA has been formally studied in very few liver transplant patients, and the published endpoints of analysis in these studies are difficult to interpret.…”

Section: Discussionmentioning

confidence: 94%

“…Epsilon‐aminocaprioic acid (EACA) has a long history of use during liver transplantation, and its empiric use has been generally safe and well tolerated. Dosing regimens for EACA are based on observational studies that were not blinded or controlled, or in which intraoperative transfusion was used as the primary endpoint for analysis 5, 6. Furthermore, dosing regimens adapted for use during liver transplantation are based on those established for patients without liver disease, and do not account for markedly altered volume of distribution in patients with ESLD 7…”

mentioning

confidence: 99%

Quantitative assessment of fibrinogen cross-linking by ?aminocaproic acid in patients with end-stage liver disease

et al. 2004

View full text Add to dashboard Cite

Analysis of the effectiveness of antifibrinolytic therapy for liver transplant recipients is hampered by lack of quantitative assays for assessing drug effects. We adapted chemical engineering tools used in polymerization studies to quantify fibrinogen cross-linking by plasma from liver transplant patients obtained before and after ⑀aminocap-roic acid (EACA) therapy. A target fluorescein isothiocyanate-fibrinogen (FITC-fibrinogen) molecule was constructed; it fluoresces in a quantifiable pattern when in solution, and undergoes cross-linking in the presence of plasmin inhibitors. Cross-linking quenches the fluorescent signal, and the quenching is a quantifiable endpoint. Thus fluorescence from this reporter molecule can be used to assess functional improvement in fibrinogen cross-linking as a result of antifibrinolytic therapies, and it is sensitive to picomolar amounts of plasmin inhibitors and activators. Cross-linking of FITC-fibrinogen by patient plasma, before and after EACA therapy, was assessed using fluorescence spectrometry. Fluorescence patterns from FITC-fibrinogen indicated no significant cross-linking of the target fibrinogen as a consequence of EACA in posttreatment plasma. When the fibrinogen-FITC target was assayed without plasma in the presence of EACA at concentrations that bracket therapeutic levels (100 and 400 g/ml), significant fluorescence quenching (target FITCfibrinogen cross-linking) was achieved. These results suggest that fibrinogen-FITC fluorescence is sensitive enough to detect EACA activity in clinically relevant ranges, but that EACA given in usual doses is insufficient to promote fibrinogen cross-linking in patients with end-stage liver disease. (Liver Transpl 2004;10:123-128.)

show abstract

“…No apparent benefit from the administration of epsilon‐aminocaproic acid administration on the requirements for ABT was found in three small randomized placebo‐controlled studies 31,38,39 . Similarly, a retrospective study including 36 patients did not show a reduction in the ABT rate 40…”

Section: Module I Pharmacological Alternatives To Reduce Blood Lossmentioning

confidence: 94%

Spanish consensus statement on alternatives to allogeneic transfusions: the ‘Seville document’

Leal-Noval

Múñoz

Páramo

et al. 2006

Transfus Alt Transfus Med

View full text Add to dashboard Cite

SUMMARY The Consensus Document on Alternatives to Allogeneic Blood Transfusion (AABT) has been drawn up by a panel of experts from five scientific societies. The Spanish societies of anesthesiology (SEDAR), critical care medicine and coronary units (SEMICYUC), hematology and hemotherapy (AEHH), blood transfusion (SETS), and thrombosis and hemostasis (SETH) have sponsored and participated in this consensus document. Alternatives to blood transfusion have been divided into pharmacological and nonpharmacological, with four modules and 12 topics. The main objective variable was the reduction of allogeneic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi methodology, which classifies the grades of recommendation from ‘A’ (supported by controlled studies) to ‘E’ (noncontrolled studies and expert opinion). The experts concluded that most of the indications for AABT only attained middle or low grades of recommendation, ‘C’, ‘D’ or ‘E’, thus indicating the need for further controlled studies.

show abstract

Comparative study of antifibrinolytic drugs in orthotopic liver transplantation

Cited by 18 publications

References 3 publications

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Quantitative assessment of fibrinogen cross-linking by ?aminocaproic acid in patients with end-stage liver disease

Spanish consensus statement on alternatives to allogeneic transfusions: the ‘Seville document’

Contact Info

Product

Resources

About