Evidence for a rebalanced hemostatic system in pediatric liver transplantation: A prospective cohort study

Abstract

Abbreviations: ADAMTS13, a disintegrin and metalloproteinase with thrombospondin motifs type 13; APTT, activated partial thromboplastin time; CLT, clot lysis time; ETP, endogenous thrombin potential; IQR, interquartile ranges; MELD score, model for end-stage liver disease score; PAI-1, plasminogen activator inhibitor type 1; PELD score, pediatric end-stage liver disease score; PT, prothrombin time; VWF, von Willebrand factor.

In Vitro Evaluation of Pro- and Anticoagulant Drugs in Children with End-Stage Liver Disease Undergoing Liver Transplantation

“…In patients with endstage liver disease (ESLD), a proportionate decrease in both proand antihemostatic factors occurs, resulting in a "rebalanced hemostasis." [4][5][6][7] This rebalanced hemostatic state is very delicate and can easily be disturbed and turn into a hypo-or hypercoagulable state, especially during invasive procedures such as transplantation. 8,9 We have recently reported the hemostatic changes observed during pediatric LT. 4 At baseline, these children were characterized by thrombocytopenia which appeared balanced by high von Willebrand factor and low a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 levels, normal thrombin generating capacity, and a preserved fibrinolytic status in most patients.…”

Thrombin Generation and Cirrhosis: State of the Art and Perspectives

“…Future studies on TGA place in the management of bleeding and thrombosis events in patients with acute liver failure and in patients undergoing partial liver resection or liver transplant surgery should follow similar principles, as discussed in this manuscript. 51,68,69 TGA with TM takes the interplay between all pro-and anticoagulants into account, and therefore has a definite added value compared with other whole blood tests of hemostasis, such as thromboelastography and rotational thromboelastometry. This point is relevant for all patients with simultaneous alterations in pro-and anticoagulant proteins.…”

Efficacy of pro‐ and anticoagulant strategies in plasma of patients undergoing hepatobiliary surgery

“…1,13 For example, routine hemostasis tests suggest a hypocoagulable state in patients with end-stage liver disease before OLT, but when tested with thrombin generation tests that take the balance between pro-and anticoagulant processes into account, patients appear in hemostatic balance, and even have hypercoagulable features. [14][15][16][17] Indeed, centers now report that many of their liver transplant recipients can undergo the procedure without the use of any blood product transfusions, a clinical confirmation that patients are not overtly hypocoagulable. 18 Similarly, although routine hemostatic tests may suggest a hypocoagulable state following OLT or partial hepatectomy, thrombin generation tests, or viscoelastic assays may show normo-to hypercoagulability.…”

“…Prediction of bleeding or thrombosis in this setting is difficult as routine tests of hemostasis, such as the prothrombin time or platelet count, do not appear to reflect actual hemostatic status 1,13 . For example, routine hemostasis tests suggest a hypocoagulable state in patients with end‐stage liver disease before OLT, but when tested with thrombin generation tests that take the balance between pro‐ and anticoagulant processes into account, patients appear in hemostatic balance, and even have hypercoagulable features 14‐17 . Indeed, centers now report that many of their liver transplant recipients can undergo the procedure without the use of any blood product transfusions, a clinical confirmation that patients are not overtly hypocoagulable 18 .…”