Intravascular thrombosis and thromboembolism during liver transplantation: Antifibrinolytic therapy implicated?

This case report describes a patient who underwent orthotopic liver transplantation and developed extensive hyperacute venous and arterial intravascular thromboses and thromboemboli intraoperatively. The patient was receiving antifibrinolytic therapy with aprotinin. The safety of routine aprotinin therapy in liver transplantation is examined. The value of the thrombelastograph (TEG) as a qualitative assessment of the coagulation system is emphasized. (Liver Transpl 2004;10:310–314.)

[1]  R. Porte,et al.  Aprotinin and thromboembolism in liver transplantation: is there really a causal effect? , 2002, Anesthesia and analgesia.

[2]  C. Legnani,et al.  Aprotinin in orthotopic liver transplantation: Evidence for a prohemostatic, but not a prothrombotic, effect , 2001, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[3]  S. Aggarwal,et al.  Intracardiac thrombus formation and pulmonary thromboembolism immediately after graft reperfusion in 7 patients undergoing liver transplantation , 2001, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[4]  D. Raines,et al.  Aprotinin administration and pulmonary thromboembolism during orthotopic liver transplantation: report of two cases. , 2001, Anesthesia and analgesia.

[5]  E. Norfleet,et al.  Fatal thrombosis associated with a hemi-fontan procedure, heparin-protamine reversal, and aprotinin. , 2001, Anesthesiology.

[6]  L. Lindgren,et al.  Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study , 2000, The Lancet.

[7]  J. Levy,et al.  Case 3--1999. Intraoperative coronary thrombosis in association with low-dose aprotinin therapy. , 1999, Journal of cardiothoracic and vascular anesthesia.

[8]  M. DePerio,et al.  Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. , 1999, Anesthesia and analgesia.

[9]  R. Bertina,et al.  Activation of the protein C system during cardiopulmonary bypass with and without aprotinin. , 1998, The Annals of thoracic surgery.

[10]  B. Chaitman,et al.  Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial. , 1998, The Journal of thoracic and cardiovascular surgery.

[11]  J. Corral,et al.  Polymorphisms of platelet membrane glycoprotein Ib associated with arterial thrombotic disease. , 1998, Blood.

[12]  T. Zama,et al.  Coronary artery disease and polymorphisms in a receptor mediating shear stress-dependent platelet activation. , 1997, Circulation.

[13]  M. Ramsay.  The use of antifibrinolytic agents results in a reduction in transfused blood products during liver transplantation. , 1997, Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[14]  P. Robbins,et al.  Use of aprotinin therapy in a patient with factor V Leiden. , 1997, Anesthesia and analgesia.

[15]  L. Muhlbaier,et al.  Aprotinin: safe and effective only with the full-dose regimen. , 1996, The Annals of thoracic surgery.

[16]  M. Ramsay,et al.  Brief communications Aprotinin and aortic cannula thrombosis , 1996 .

[17]  P. Kuo,et al.  Intracardiac thrombus formation during orthotopic liver transplantation: a new entity or an old enemy? , 1996, Transplantation.

[18]  M. Ramsay,et al.  Aprotinin and aortic cannula thrombosis. , 1996, The Journal of thoracic and cardiovascular surgery.

[19]  J. Mark,et al.  Early thrombus formation on heparin-bonded pulmonary artery catheters in patients receiving epsilon aminocaproic acid. , 1995, Anesthesiology.

[20]  P. Duvaldestin,et al.  A fatal thrombotic complication during liver transplantation after aprotinin administration. , 1994, Transplantation.

[21]  D. Royston.  Intraoperative coronary thrombosis: can aprotinin be incriminated? , 1994, Journal of cardiothoracic and vascular anesthesia.

[22]  H. Teufelsbauer,et al.  Aprotinin does not decrease early graft patency after coronary artery bypass grafting despite reducing postoperative bleeding and use of donated blood. , 1994, The Journal of thoracic and cardiovascular surgery.

[23]  S. Mallett,et al.  Aprotinin and reduction of blood loss and transfusion requirements in orthotopic liver transplantation , 1990, The Lancet.

[24]  C. Vahl,et al.  Early formation of thrombi on pulmonary artery catheters in cardiac surgical patients receiving high-dose aprotinin. , 1990, Journal of cardiothoracic anesthesia.

[25]  S. Feinstein,et al.  Right Heart Dysfunction, Pulmonary Embolism, and Paradoxical Embolization during Liver Transplantation: A Transesophageal Two‐Dimensional Echocardiographic Study , 1989, Anesthesia and analgesia.

[26]  T. Starzl,et al.  Systemic effects of tissue plasminogen activator-associated fibrinolysis and its relation to thrombin generation in orthotopic liver transplantation. , 1989, Transplantation.

[27]  T. Starzl,et al.  Epsilon‐aminocaproic Acid for Treatment of Fibrinolysis during Liver Transplantation , 1987, Anesthesiology.

[28]  R. Tubbs,et al.  Recurrent subarachnoid hemorrhage associated with aminocaproic acid therapy and acute renal artery thrombosis. Case report. , 1979, Journal of neurosurgery.

[29]  A. H. Koo,et al.  Cerebral thrombosis associated with Amicar therapy. , 1979, Radiology.