Correction of the Fibrinolytic Type of the Disseminated Intravascular Coagulation Syndrome in the Early Postoperative Period

Abstract

Objective: to comparatively evaluate the efficiency and safety of trasylol and aprotex used in the treatment of the fibrinolytic type of disseminated intravascular coagulation (DIC) syndrome after long abdominal operations. Materials and methods. The authors examined patients undergone long abdominal operations (pancreatoduodenal resection, hemihepatectomy, hemicolectomy, reconstructive operations on the bile duct) and those with a pyoseptic process (peritonitis, pancreatonecrosis) who had on admission to the intensive care unit the signs of fibrinolytic DIC syndrome: elevated levels of fibrin/fibrinogen degradation products > 10 ^g/ml, shorter euglobulin lysis < 180 min, and increased fibrinolytic potential (> 1.1 conventional unit) in the presence of a porous clot, as evidenced by an electrocoagulogram. Results. The use of protease inhibitors in the fibrinolytic type of the DIC syndrome in the early postoperative period could reduce needs for blood transfusion by 47—67%, fresh frozen plasma transfusion by 47-68%, and drainage losses by 57—73%. As compared with the baseline values, there was no significant difference with the use of small-dose trasylol. Conclusion. In the fibrinolytic type of DIC syndrome, aprotinin should be an integral part of intensive care. Comparison of the efficacy of trasylol and aprotex suggest the equivalence of both aprotinin drugs used in equivalent doses. It is unacceptable to use of small-dose aprotinin in surgery as this makes it impossible to rapidly correct hemostatic disturbances and thus to reduce blood loss.