CONTINUOUS SMALL-DOSE TRANEXAMIC ACID REDUCES FIBRINOLYSIS BUT NOT TRANSFUSION REQUIREMENTS DURING ORTHOTOPIC LIVER-TRANSPLANTATION

Tranexamic acid (TA) is a synthetic drug that inhibits fibrinolysis. I t has been administered to decrease the use of blood products during c ardiac surgery and orthotopic liver transplantation when infused in la rger doses. A small-dose infusion of aprotinin causes a reduction in f ibrinolysis and blood product requirement during orthotopic liver tran splantation without apparent risk of intravascular thrombosis. This pr ospective study was designed to investigate whether a small-dose infus ion of TA would be equally effective in reducing fibrinolysis and bloo d product transfusions during orthotopic liver transplantation A doubl e-blind, controlled study was undertaken to compare the efficacy of a small-dose TA infusion with that of a placebo. Thirty-two consecutive patients were randomized either to the TA group (n = 26), which receiv ed an intravenous infusion of 2 mg.kg(-1).h(-1), or to the control gro up (n = 16), which received an identical volume of normal saline. Coag ulation values were measured, a field rating was made by the surgeon, and a thrombelastogram was produced at four predetermined intervals th roughout the case-before TA infusion was started, after portal vein li gation, 10 min after reperfusion, and at the end of surgery. Intraoper ative transfusion requirements were recorded during the procedure and for the first 24 h postoperatively. A record was kept of any intraoper ative E-aminocaproic acid administered for uncontrolled fibrinolysis. The thrombelastogram clot lysis index was significant for lysis in the control group during both the anhepatic and the neohepatic phases (P < 0.01 and P < 0.05, respectively) when compared with the TA group. Fi brin degradation products were significantly increased (>20 mu g/mL) i n the control group at reperfusion (P < 0.03) and at the end of surger y (P < 0.01). D-dimers were also significantly increased (>1 mg/L) in the control group at the end of surgery (P < 0.04). Nine of the 16 con trol patients versus 3 of the 16 TA patients required epsilon-aminocap roic acid rescue for fibrinolysis. There were no other significant dif ferences between groups. Transfusion requirements during surgery and f or the first 24 h postoperatively did not differ significantly between the two groups. We conclude that the use of small-dose TA reduces fib rinolysis but not transfusion requirements during orthotopic liver tra nsplantation.