Correcting prolonged bleeding during renal transplantation with estrogen or plasma
G. L. Boyd, A. G. Diethelm, S. Gelman, R. Langner, D. Laskow, M. Deierhoi and W. H. Barber
Department of Anesthesiology, University of Alabama at Birmingham, USA.
OBJECTIVE: To determine the efficacy and relative effectiveness of
conjugated entrogens (CE) and fresh-frozen plasma (FFP) in normalizing
prolonged preoperative bleeding times during renal transplantation. DESIGN:
Prospective, randomized trial. SETTING: A university regional referral
center for transplantation. PATIENTS: Patients scheduled for renal
transplantation with preoperative bleeding times greater than 10 minutes
(normal, < 7 minutes) following informed consent were asked to
participate in the randomized protocol. Those with bleeding times of 8 to
9.5 minutes were asked, following informed consent, to be a control group
receiving neither CE nor FFP. INTERVENTIONS: Following induction of
anesthesia and drawing of baseline laboratory tests, patients were
administered randomly, using a table of random numbers, either 50 mg of CE
or 2 U of FFP. MAIN OUTCOME MEASURES: Bleeding time measurements and other
laboratory tests were repeated at the end of surgery as well as at 24 and
48 hours postoperatively. RESULTS: Treatment with CE and FFP decreased the
patients' bleeding times from 16.68 +/- 0.8 (SEM) and 17.13 +/- 0.85
minutes to 7.67 +/- 0.79 (P < .001) and 10.50 +/- 1.27 minutes (P <
.001), respectively, by the end of surgery. At 24 and 48 hours
postoperatively, the CE group had bleeding times of 9.77 +/- 0.99 and 9.81
+/- 1.24 minutes (P < .001 for both), respectively, whereas the FFP
group bleeding times were 12.76 +/- 1.57 (P = .003) and 12.14 +/- 1.56
minutes (P = .001), respectively. There were no statistical differences for
the control group compared with baseline either at the end of surgery or at
24 hours. CONCLUSIONS: Although both CE and FFP significantly decreased
prolonged preoperative bleeding times during renal transplantation, CE
might be preferred because of lower risk and cost, as well as a longer
duration of action.
