TY - JOUR
T1 - Aprotinin and the Risk of Thrombotic Complications After Liver Transplantation
T2 - A Retrospective Analysis of 1492 Patients
AU - Warnaar, Nienke
AU - Mallett, Susan V.
AU - Klinck, John R.
AU - de Boer, Marieke T.
AU - Rolando, Nancy
AU - Burroughs, Andrew K.
AU - Jamieson, Neville V.
AU - Rolles, Keith
AU - Porte, Robert J.
PY - 2009/7
Y1 - 2009/7
N2 - Aprotinin is an antifibrinolytic drug that reduces blood loss during orthotopic liver transplantation (OLT). Case reports have suggested that aprotinin may be associated with an increased risk of thromboembolic complications. Recent studies in cardiac surgery also have suggested a higher risk of renal failure and postoperative mortality. Despite these concerns, no large-scale safety assessment has been performed in OLT. In a retrospective observational study involving 1492 liver transplants, we studied the occurrence of postoperative thromboembolic or thrombotic events and mortality in patients who received aprotinin (n = 907) and patients who did not (n = 585). The overall incidence of hepatic artery thrombosis and central venous complications (pulmonary embolism or interior vena cava thrombosis) was 3.2% and 0.9%, respectively. In propensity score-adjusted analyses (C-index = 0.79), aprotinin was not associated with an increased risk of hepatic artery thrombosis [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.50-2.01, P = 0.86]. Although central venous complications were found more frequently in patients receiving aprotinin, the difference was not statistically significant (OR = 2.95, 95% CI = 0.54-16.23, P = 0.32). In addition, no significant differences were found in 1-year mortality (OR = 1.21, 95% CI = 0.86-1.71, P = 0.32). In conclusion, this study did not demonstrate an increased risk of thrombotic complications or mortality when aprotinin is used during OLT. Liver Transpl 15:747-753, 2009. (C) 2009 AASLD.
AB - Aprotinin is an antifibrinolytic drug that reduces blood loss during orthotopic liver transplantation (OLT). Case reports have suggested that aprotinin may be associated with an increased risk of thromboembolic complications. Recent studies in cardiac surgery also have suggested a higher risk of renal failure and postoperative mortality. Despite these concerns, no large-scale safety assessment has been performed in OLT. In a retrospective observational study involving 1492 liver transplants, we studied the occurrence of postoperative thromboembolic or thrombotic events and mortality in patients who received aprotinin (n = 907) and patients who did not (n = 585). The overall incidence of hepatic artery thrombosis and central venous complications (pulmonary embolism or interior vena cava thrombosis) was 3.2% and 0.9%, respectively. In propensity score-adjusted analyses (C-index = 0.79), aprotinin was not associated with an increased risk of hepatic artery thrombosis [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.50-2.01, P = 0.86]. Although central venous complications were found more frequently in patients receiving aprotinin, the difference was not statistically significant (OR = 2.95, 95% CI = 0.54-16.23, P = 0.32). In addition, no significant differences were found in 1-year mortality (OR = 1.21, 95% CI = 0.86-1.71, P = 0.32). In conclusion, this study did not demonstrate an increased risk of thrombotic complications or mortality when aprotinin is used during OLT. Liver Transpl 15:747-753, 2009. (C) 2009 AASLD.
KW - HEPATIC-ARTERY THROMBOSIS
KW - PRIMARY BILIARY-CIRRHOSIS
KW - PROPENSITY SCORE
KW - CARDIAC-SURGERY
KW - BLOOD-LOSS
KW - TRANSFUSION REQUIREMENTS
KW - TRANEXAMIC ACID
KW - COAGULATION
KW - THROMBOEMBOLISM
KW - FIBRINOLYSIS
U2 - 10.1002/lt.21768
DO - 10.1002/lt.21768
M3 - Article
SN - 1527-6465
VL - 15
SP - 747
EP - 753
JO - Liver Transplantation
JF - Liver Transplantation
IS - 7
ER -