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Die Wirkung von Aprotinin

Blutverlust und Gerinnungsparameter bei orthotoper Lebertransplantation: Eine klinisch-experimentelle, prospektive und randomisierte Doppelblindstudie

Effect of aprotinin on blood loss and coagulation parameters in orthotopic liver transplantation

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Zusammenfassung

In einer randomisierten Doppelblindstudie wurde der Effekt von Aprotinin (2000000 KIE als Bolus+500000 KIE/h bis zum Ende der Operation, Verumgruppe n=9; Plazebogruppe n=9) auf Gerinnungsparameter und Transfusionsbedarf bei orthotoper Lebertransplantation untersucht. Alle Patienten wurden mit Hilfe eines fahrbaren Gerinnungslabors intraoperativ optimal überwacht. Im Gegensatz zu anderen Arbeitsgruppen fand sich unter diesen Bedingungen für den Transfusionsbedarf kein signifikanter Unterschied zwischen Verum- und Plazebogruppe. Dagegen beobachteten wir einen günstigen Effekt des Proteinaseninhibitors auf verschiedene Gerinnungsparameter, besonders in der Reperfusionsphase. Offensichtlich wird die Kontaktaktivierung des intrinsischen Gerinnungssystems, die durch geschädigte Gefäße des transplantierten Organs eingeleitet wird, durch Aprotinin gehemmt.

Abstract

The effect of aprotinin (2000000 IU as a bolus +500000 JU/h until the end of the operation) on transfusion requirements and coagulation parameters in orthotopic liver transplantation (study group: n=9; placebo group: n=9) was investigated in a randomised, double-blind study. Coagulation parameters were monitored intraoperatively using a mobile laboratory. In contrast to the published results, no effect on transfusion requirements could be demonstrated. However, aprotinin showed a positive effect on some coagulation parameters in the reperfusion phase. The mechanism appeared to be inhibition of the contact activation of the intrinsic system with less thrombin generation in the study group.

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Authors and Affiliations

  1. Institut für Klinische Chemie, Ludwig Maximilians-Universität München, München, Deutschland

    M. A. A. Kratzer

  2. Institut für Anästhesiologie, Ludwig Maximilians-Universität München, München, Deutschland

    S. C. Azad, J. Groh, M. Welte & M. Haller

  3. Chirurgische Klinik des Klinikums Großhadern, Ludwig Maximilians-Universität München, München, Deutschland

    E. Pratschke

Authors
  1. M. A. A. Kratzer
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  2. S. C. Azad
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  3. J. Groh
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  4. M. Welte
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  5. M. Haller
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  6. E. Pratschke
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Kratzer, M.A.A., Azad, S.C., Groh, J. et al. Die Wirkung von Aprotinin. Anaesthesist 46, 294–302 (1997). https://doi.org/10.1007/s001010050404

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  • DOI: https://doi.org/10.1007/s001010050404

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