Bleeding in Liver Surgery: Prevention and Treatment

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

“…[1][2][3][4][5] Despite many technical advances, intraoperative bleeding remains a problem during liver resection with 30-40% of patients receiving perioperative blood transfusions. [6][7][8] Blood transfusion carries several risks, including transfusion-transmitted viruses, transfusion-related acute lung injury, transfusion-associated circulatory overload, acute hemolytic transfusion reactions, bacterial contamination and severe allergic reactions. 9 In addition, bleeding and blood transfusion are risk factors for postoperative morbidity and in some reports, long-term cancer recurrence.…”

“…9 In addition, bleeding and blood transfusion are risk factors for postoperative morbidity and in some reports, long-term cancer recurrence. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22] Furthermore, blood products are sometimes scarce and associated with appreciable expense. Thus, there is compelling rationale to reduce blood loss and blood transfusion as much as possible in patients undergoing liver resection.…”

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

“…4 Hepatectomy carries a substantial risk of acute hemorrhage necessitating blood transfusion, which are known predictors of both mortality and morbidity. [6][7][8][9][10] The median estimated blood loss for open and minimally invasive hepatectomy in several series ranges from 120 to 600 mL. 11,12 Up to 49% of patients undergoing elective hepatectomy are transfused blood products at any time during their index admission with an average of 2.6-4.0 units of red blood cells transfused in the perioperative period.…”

Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation

“…Nowadays the strength of evidence is low or moderate for intraoperative blood saving capability when given as prophylaxis; furthermore use of rFⅦa has been associated with an increased rate of thromboembolic events in intracerebral hemorrhage and cardiac surgery [87] . Therefore the prophylactic administration may not be the most efficient use of this drug; it should instead be seen more as a "rescue therapy" to control bleeding in situations of major perioperative bleeding where other therapies have failed [88] . Case reports and studies with small number of patients found this drug beneficial in correcting clotting alterations, reducing frank surgical bleeding, controlling clotting failure due to graft reperfusion, or stabilizing clotting functions before the closure of the abdomen [89,90] .…”