Epsilon-Aminocaproic Acid Has No Association With Thromboembolic Complications, Renal Failure, or Mortality After Liver Transplantation

Nicolau‐Raducu, Ramona; Ku, Timothy C.; Ganier, Donald; Evans, Brian; Koveleskie, Joseph; Daly, William J.; Fish, Brian L.; Cohen, Ari J.; Reichman, Trevor; Bohórquez, Humberto; Bruce, David S.; Carmody, Ian C.; Loss, George E.; Gitman, Marina; Marshall, Thomas; Nossaman, Bobby D.

doi:10.1053/j.jvca.2015.12.003

Cited by 29 publications

(24 citation statements)

References 25 publications

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“…Mechanical compression stockings were used intraoperatively in all recipients. In July 2017, routine intraoperative thromboprophylaxis with intravenous heparin (30 units/kg) was instituted at the time of portal clamping in all recipients. Once the postoperative platelet count was >40 × 10 9 /L, 5000 units of subcutaneous heparin every 12 hours plus 81 mg of aspirin per os were initiated.…”

Section: Methodsmentioning

confidence: 99%

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

et al. 2019

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Detrimental consequences of hypofibrinolysis, also known as fibrinolysis shutdown (FS), have recently arisen, and its significance in liver transplantation (LT) remains unknown. To fill this gap, this retrospective study included 166 adults who received transplants between 2016 and 2018 for whom baseline thromboelastography was available. On the basis of percent of clot lysis 30 minutes after maximal amplitude, patients were stratified into 3 fibrinolysis phenotypes: FS, physiologic fibrinolysis, and hyperfibrinolysis. FS occurred in 71.7% of recipients, followed by physiologic fibrinolysis in 19.9% and hyperfibrinolysis in 8.4%. Intraoperative and postoperative venous thrombosis events occurred exclusively in recipients with the FS phenotype. Intraoperative thrombosis occurred with an overall incidence of 4.8% and was associated with 25.0% in-hospital mortality. Incidence of postoperative venous thrombosis within the first month was deep venous thrombosis/pulmonary embolism (PE; 4.8%) and portal vein thrombosis/ hepatic vein thrombosis (1.8%). Massive transfusion of ≥20 units packed red blood cells was required in 11.8% of recipients with FS compared with none in the other 2 phenotype groups (P = 0.01). Multivariate analysis identified 2 pretransplant risk factors for FS: platelet count and nonalcoholic steatohepatitis/cryptogenic cirrhosis. Recursive partitioning identified a critical platelet cutoff value of 50 × 10 9 /L to be associated with FS phenotype. The hyperfibrinolysis phenotype was associated with the lowest 1-year survival (85.7%), followed by FS (95.0%) and physiologic fibrinolysis (97.0%). Infection/multisystem organ failure was the predominant cause of death; in the FS group, 1 patient died of exsanguination, and 1 patient died of massive intraoperative PE. In conclusion, there is a strong association between FS and thrombohemorrhagic complications and poorer outcomes after LT. Liver Transplantation 25 380-387 2019 AASLD.

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Section: Methodsmentioning

confidence: 99%

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

et al. 2019

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“…(2,3) We found no association between postreperfusion antifibrinolytic therapy and thromboembolic complications. (6) In conclusion, despite the study limitations, the article by Groose et al (1) supports routine heparin thromboprophylaxis for ICT-prone high-risk LT recipients.…”

Section: To the Editormentioning

confidence: 87%

Risk Factors for Intracardiac Thrombus During Liver Transplantation

Nicolau‐Raducu¹,

Raveh²

2019

Liver Transpl

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“…In people, the incidence of thromboembolism associated with the administration of antifibrinolytic agents is reported to be low (Ker et al 2015, Nicolau-Raducu et al 2016, Juhl et al 2018, but this has not been established in cats and dogs. Empirical use of these drugs is therefore not recommended in patients with prothrombotic conditions.…”

Section: Treatment Of Hyperfibrinolytic Disordersmentioning

confidence: 99%

A review of hyperfibrinolysis in cats and dogs

Birkbeck

Humm

Cortellini

2019

J of Small Animal Practice

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The fibrinolytic system is activated concurrently with coagulation; it regulates haemostasis and prevents thrombosis by restricting clot formation to the area of vascular injury and dismantling the clot as healing occurs. Dysregulation of the fibrinolytic system, which results in hyperfibrinolysis, may manifest as clinically important haemorrhage. Hyperfibrinolysis occurs in cats and dogs secondary to a variety of congenital and acquired disorders. Acquired disorders associated with hyperfibrinolysis, such as trauma, cavitary effusions, liver disease and Angiostrongylus vasorum infection, are commonly encountered in primary care practice. In addition, delayed haemorrhage reported in greyhounds following trauma and routine surgical procedures has been attributed to a hyperfibrinolytic disorder, although this has yet to be characterised. The diagnosis of hyperfibrinolysis is challenging and, until recently, has relied on techniques that are not readily available outside referral hospitals. With the recent development of point‐of‐care viscoelastic techniques, assessment of fibrinolysis is now possible in referral practice. This will provide the opportunity to target haemorrhage due to hyperfibrinolysis with antifibrinolytic drugs and thereby reduce associated morbidity and mortality. The fibrinolytic system and the conditions associated with increased fibrinolytic activity in cats and dogs are the focus of this review article. In addition, laboratory and point‐of‐care techniques for assessing hyperfibrinolysis and antifibrinolytic treatment for patients with haemorrhage are reviewed.

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Epsilon-Aminocaproic Acid Has No Association With Thromboembolic Complications, Renal Failure, or Mortality After Liver Transplantation

Cited by 29 publications

References 25 publications

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

Risk Factors for Intracardiac Thrombus During Liver Transplantation

A review of hyperfibrinolysis in cats and dogs

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