2 research outputs found
Fibrinolysis during liver transplantation is enhanced by using solvent/detergent virus-inactivated plasma (ESDEP)
After the introduction of solvent/detergent-treated plasma (ESDEP) in our
hospital, an increased incidence of hyperfibrinolysis was observed (75% vs
29%; P = 0.005) compared with the use of fresh frozen plasma for liver
transplantation. To clarify this increased incidence, intraoperative
plasma samples of patients treated with fresh frozen plasma or ESDEP were
analyzed in a retrospective observational study. During the anhepatic
phase, plasma levels of D-dimer (6.58 vs 1.53 microg/mL; P = 0.02) and
fibrinogen degradation products (60 vs 23 mg/L; P = 0.018) were
significantly higher in patients treated with ESDEP. After reperfusion,
differences increased to 23.5 vs 4.7 microg/mL (D-dimer, P = 0.002) and
161 vs 57 mg/L (fibrinogen degradation products, P = 0.001). The amount of
plasma received per packed red blood cell concentrate, clotting tests, and
levels of individual clotting factors did not show significant differences
between the groups. alpha(2)-Antiplasmin levels, however, were
significantly lower in patients receiving ESDEP during the anhepatic phase
(0.37 vs 0.65 IU/mL; P < 0.001) and after reperfusion (0.27 vs 0.58 IU/mL;
P = 0.001). Analysis of alpha(2)-antiplasmin levels in ESDEP alone showed
a reduction to 0.28 IU/mL (normal >0.95 IU/mL) because of the
solvent/detergent process. Therapeutic consequences for the use of ESDEP
in orthotopic liver transplantation are discussed in view of an increased
incidence of hyperfibrinolysis caused by reduced levels of
alpha(2)-antiplasmin in the solvent/detergent-treated plasma.
IMPLICATIONS: The use of solvent/detergent virus-inactivated plasma is of
increasing importance in the prevention of human immunodeficiency virus
and hepatitis C virus transmission. Since the use of this plasma during
orthotopic liver transplantation has increased, the incidence of
hyperfibrinolysis was observed. Clotting analysis of the patients revealed
small alpha(2)-antiplasmin concentrations because of the solvent/detergent
process
Beta-Blocking Agents and Electroconvulsive Therapy
In this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking
adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular
variables. We sea