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Article |

Correcting Prolonged Bleeding During Renal Transplantation With Estrogen or Plasma

Gwendolyn L. Boyd, MD; Arnold G. Diethelm, MD; Simon Gelman, MD, PhD; Rebecca Langner, MSN; David Laskow, MD; Mark Deierhoi, MD; W. Henry Barber, MD, DPhil
Arch Surg. 1996;131(2):160-165. doi:10.1001/archsurg.1996.01430140050013.
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Objective:  To determine the efficacy and relative effectiveness of conjugated entrogens (CE) and freshfrozen 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.(Arch Surg. 1996;131:160-165)


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