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Aprotinin in the treatment of hemorrhagic shock trauma patients

The conservative treatment of bleeding from solid abdominal organs has been traditionally based on massive fluid resuscitation and correction of coagulopathy, which has latelybeen recognized as detrimental. // Although there are new and sophisticated methods for the control of hemorrhage, bleeding is still the direct cause of death in up to 40% of trauma-related deaths.

There is a continuous search for the "magical drug" that can improve coagulation, reduce bleeding, and increase the time span between the injury and the occurrence of irreversible shock. Early administration of such drug in the field would allow more injured patients to reach the surgical facility, where the means for bleeding control is available.

Aprotinin is known to promote clot formation through its antifibrinolytic activity, by inhibiting the plasmin-induced complement activation and by protecting the platelets adhesive surface receptors. It has been successfully used in cardiac and liver transplantation surgery.

In view of its properties in clot formation, improved coagulation, and its antifibrinolytic activity, a recent study was designed to evaluate the effect of aprotinin in a model of uncontrolled intra-abdominal bleeding as the basis for potential use in trauma patients.

For the study, published in the September issue of The American Journal of Surgery, 20 rats were randomly divided into 2 groups. All animals were operated on and bleeding was induced by transecting 1 lobe of the liver. In the treatment group a single dose of 30,000 U/kg of aprotinin was administered 5 minutes after the injury. The animals were monitored for hemodynamic parameters, blood loss volume, and mortality rates.

Early administration of aprotinin resulted in temporary hemodynamic stabilization and prolonged survival in a model of uncontrolled bleeding. Further studies are needed to establish the possible use of aprotinin in the treatment of trauma patients .

The authors stress that in view of the results of this present study and the data already published on the uses of aprotinin in situations where bleeding is of major concern, further studies are warranted to establish the possible use of aprotinin in the treatment of trauma patients.
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