patients with liver disease is estimated to occur in 0.35% .
correcting laboratory parameters of coagulopathy in patients
with fulminant hepatic failure, as it facilitates the performance
of invasive procedures and is associated with less frequent
anasarca compared with conventional therapy. It was reported
that rFVIIa was used in a patient undergoing for liver
transplant to stop the bleeding during the procedure .
could be successfully used to perform the procedure without
any complications. However, our preliminary experience
warrants the need for further studies with a larger number of
patients to define the optimal dosing, safety, and efficacy of
rFVIIa in patients with coagulopathy requiring liver biopsy.
Disclosure of Conflict of Interests
The authors state that they have no conflict of interest.
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Assessment of hemostasis through the retrospectroscope
R. B. WEISKOPF
Novo Nordisk, Bagsvaerd, Denmark and Department of Anesthesia, University of California, San Francisco, CA, USA
To cite this article: Weiskopf RB. Assessment of hemostasis through the retrospectroscope. J Thromb Haemost 2006; 4: 2074–8.
See also Levy JH. Aprotinin is useful as a hemostatic agent in cardiopulmonary surgery: yes. This issue, pp 1875–8; Karkouti K, Beattie WS.
Aprotinin is useful as a hemostatic agent in cardiopulmonary surgery: no. This issue, pp 1879–81.
Aprotinin is approved in the USA for use in coronary artery
graft surgery with cardio-pulmonary bypass (CPB) to decrease
bleeding and transfusion of erythrocytes ; in the UK for
patients at high risk for bleeding in association with cardiac
surgery and CPB; and in many other countries for similar
indications. It is used routinely during cardiac surgery at some
institutions, while at other institutions it is used only for
patients thought to be at high risk for bleeding. There are
reports of efficacy in orthopedic surgery as well, including a
than are those from cardiac surgery .
In this issue of the Journal, Levy  and Karkouti and
its approved use. This debate was stimulated by three recent
reports of retrospective analyses of cardiac surgery databases
that have questioned the renal safety of aprotinin [6–8]. This
article addresses those reports and the issues they raise.
reported a statistically significant increase in serum creatinine
concentration ; none has reported an increased incidence of
renal failure. The major problem with the three recent
publications is their retrospective nature. Using statistical
methodology, such as propensity analysis, these authors
attempted to reduce bias. It is possible that some bias was
Correspondence: Richard B. Weiskopf, Novo Nordisk A/S, Novo
Alle, DK-2880 Bagsvaerd, Denmark.
2074 Letters to the Editor
? 2006 International Society on Thrombosis and Haemostasis