Coagulation management during liver transplantation

Goerlinger, Klaus

doi:10.1055/s-0037-1617084

Cited by 100 publications

(128 citation statements)

References 67 publications

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“…The value of ROTEM has also been reported for cardiac surgery and liver transplantations 6,7,17 , where it is particularly important to be able to monitor the coagulation in real time. Unfortunately, such real-time monitoring is not feasible with standard laboratory coagulation tests.…”

Section: Discussionmentioning

confidence: 99%

“…It can be used in the laboratory or at the patient bedside. [6][7][8][9] We recently showed ª 2009 The Authors Journal compilation ª RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology that the ROTEM system allows the detection of hypercoagulation linked to pregnancy. We also showed that ROTEM gives a reliable and rapid assessment of coagulation during normal pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Huissoud

Carrabin

Audibert

et al. 2009

BJOG

207

161

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Objectives To establish whether reagent-supported thrombelastometry with the rotation thrombelastometry system (ROTEM Ò ) point-of-care device correlated with fibrinogen level in postpartum haemorrhages.Design Prospective observational study.Population and setting Ninety-one women at the third trimester of pregnancy: 37 with postpartum haemorrhage (study group) and 54 without abnormal bleeding (control group).Methods Standard laboratory test results were compared with those obtained at bedside from the ROTEM with the FIBTEM Ò test (54 tests in the control group and 51 in the study group). Results Median fibrinogen level was significantly lower in the haemorrhage group than in the control group (3.4 and 5.1 g/l, respectively, P < 0.0001). Median CT was higher in the haemorrhage group than in the control group (P = 0.05). CA 5 , CA 15 and MCF were significantly lower in the haemorrhage group than in controls (P < 0.0001) and strongly correlated with fibrinogen levels in both groups (r = 0.84-0.87, P < 0.0001). A cut-off value of CA 5 at 5 mm and CA 15 at 6 mm presented an excellent sensitivity (100% for both parameters) and a good specificity (respectively 85 and 88%) to detect fibrinogen levels <1.5 g/l in postpartum haemorrhage.Conclusions The early parameters obtained from the FIBTEM test correlated well with fibrinogen levels. ROTEM might be helpful in guiding fibrinogen transfusion during postpartum haemorrhage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Huissoud

Carrabin

Audibert

et al. 2009

BJOG

207

161

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“…Görlinger [79] developed and implemented a ROTEM based point of care (POC) algorithm for LT to guide response to clearly defined abnormal ROTEM parameters. A POC algorithm with first line use of factor concentrates applied to a variety of clinical contexts (trauma, cardiac, transplant and critical care) in three major teaching hospitals in Germany and Austria was associated with an impressive 90% reduction in FFP use, 72% reduction in platelet use, 62% reduction in RBC use and 50% reduction in incidence of massive transfusion and increased use of factor concentrates [80] .…”

Section: Measurement Of Teg Functional Fibrinogen (Teg Ff)mentioning

confidence: 99%

Reducing transfusion requirements in liver transplantation

Donohue

Mallett

2015

WJT

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Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT. Core tip: Liver transplantation (LT) was historically associated with massive blood loss. Many factors have contributed to the decline in bleeding and transfusion in the past two decades including refinement of surgical techniques, anaesthetic management and the use of point of care guided goal-directed haemostatic therapies. Increasing awareness of the adverse associations of allogenic transfusion has driven the quest for transfusion-free transplantation. Increasing use of marginal grafts and transplantation of sicker recipients will continue to challenge perioperative care and transfusion practice. Inter-institutional variability suggests a current lack of clear guidance and limited application of the principles of patient blood management to LT.

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“…POC-guided transfusion was associated with decreased transfusion of frozen plasma (12.8 ± 7 vs. 21.5 ± 1 2.7 units), but did not aff ect 3-year survival [16]. Analyzing more than 18, 000 thromboelastography measurements in the context of 642 patients with liver transplantation, the implementation of a POC coagu lation management based on early, calculated, goaldirected therapy with fi brinogen concentrate, prothrombin complex concentrate and antifi brinolytic therapy resulted in early detection of hyperfi brinolysis and consequently antifi brinolytic therapy [17], and a reduction in transfusion requirements for erythrocytes, fresh frozen plasma (FFP), and platelets as well as a reduced incidence of massive transfusion [18].…”

Section: Organ Transplantationmentioning

confidence: 99%