APROTININ REDUCES BLOOD-LOSS IN PATIENTS UNDERGOING ELECTIVE LIVER RESECTION

Ninety-severi patients undergoing elective liver resection through a s ubcostal incision were assigned to large-dose aprotinin treatment or p lacebo in a double-blind, prospective, randomized fashion. Randomizati on was stratified by diagnosis: (a) cancer in cirrhosis, (b) cancer in healthy liver, and (c) benign tumor in healthy liver. Intraoperative blood loss, percentage of transfused patients, and total transfusion r equirement per group were significantly lower in the aprotinin group t han in the placebo group (1217 +/- 966 mt vs 1653 +/- 1221 mt, P = 0.0 48; 17% vs 39%, P = 0.02; 30 vs 77 red blood cell packs, P = 0.015, re spectively). Assessment of hematological markers (a) prior to surgery, (b) at the end of Surgery, and (c) 24 h after surgery showed an ident ical intraoperative increase in thrombin-antithrombin III complexes in patients of both groups (P = 0.86), which indicates a similar activat ion of coagulation. Intraoperative hyperfibrinolysis was significantly less pronounced in the aprotinin group than in the placebo group (P = 0.0002 and P = 0.004 for D-dimers and fibrinogen, respectively). No a dverse drug effects were detected (circulatory disturbances, deep veno us thrombosis, increase in serum creatinine). These results suggest th at aprotinin significantly reduces blood loss and transfusion requirem ent in patients undergoing elective liver resection through a subcosta l incision.