Coagulation Defects Do Not Predict Blood Product Requirements During Liver Transplantation

Abstract

The avoidance of plasma transfusion was associated with a decrease in RBC transfusions during liver transplantation. There was no link between coagulation defects and bleeding or RBC or plasma transfusions. Previous reports indicating that it is neither useful nor necessary to correct coagulation defects with plasma transfusion before liver transplantation seem further corroborated by this study. We believe that this work also supports the practice of lowering central venous pressure with phlebotomy to reduce blood loss, during liver dissection, without any deleterious effect.

Intraoperatives Gerinnungsmanagement

“…gezeigt, dass neben Plättchenfunktionsstörungen und verminderten Plättchenzahlen auch erhöhte Faktor-VIII-und von-Willebrand-Faktor(vWF)-Konzentrationen bestehen, die die Störungen potenziell «ausgleichen» können [24]. Allgemein zeigt sich eine sogenannte «rebalancierte» Gerinnungssituation, die keine erhöhte Transfusionswahrscheinlichkeit nach sich ziehen muss [3,25]. …”

Point‐of‐care monitoring of haemostasis

“…Visco-elastic testing has been used in the management of these patients for many years [54], and has been shown to reduce the use of blood component therapy [55]. Pre-operative conventional coagulation tests are not predictive of bleeding in liver disease [56], and many of these patients have VET profiles within normal ranges, despite a raised PT/INR and thrombocytopenia [57], in keeping with the concept of 're-balanced' haemostasis [3], and the fact that many patients undergo liver transplantation without the need for blood or blood product transfusion [58].…”

Perioperative Monitoring in Liver Transplant Patients

“…The importance of TEG during LT as a test of whole-blood coagulation, has been established in literature. 36 The test allows for in vivo interactions between platelets, red blood cells and other coagulation factors and clot development is displayed in real-time.…”