ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion

Moosawi, Muntadhar Al; Trudeau, Jacqueline D.; Smith, Tyler; Lefebvre, Alexandre; Shih, Andrew W.

doi:10.1016/j.transci.2021.103125

Cited by 8 publications

(14 citation statements)

References 33 publications

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“…This systematic review and meta-analysis, based on 17 studies including 5345 liver transplantation patients, studied the role of VETs in reducing blood product transfusion during liver transplantations. Compared with previous findings [15][16][17][18][19] that highlighted an overall Certainty of evidence assessment for observational (a) and randomised controlled trials (b) Analysing all 15 observational studies, 28,[30][31][32][33][34][35][36][38][39][40][41][42][43][44] a significantly lower number of RBC units transfused was found when coagulation management was guided by VETs, with a rather moderate heterogeneity (I 2 ¼ 61%) between studies. In this regard, sensitivity analyses showed a low heterogeneity (I 2 ¼ 1%) for the reduction in RBC transfusion in the studies including only patients with MELD score 25 or less while there was no heterogeneity in those studies with specified deceased donors.…”

Section: Discussionmentioning

confidence: 93%

“…The mean age in 13 studies 29,31–34,36–43 was 53.46 ± 10.55 years and mean MELD score was 22.18 ± 8.74 calculated in 12 studies (Table 1). 29,31–33,36–43 …”

Section: Resultsmentioning

confidence: 99%

“…Analysing all 15 observational studies, 28,30–36,38–44 a significantly lower number of RBC units transfused was found when coagulation management was guided by VETs, with a rather moderate heterogeneity ( I 2 = 61%) between studies. In this regard, sensitivity analyses showed a low heterogeneity ( I 2 = 1%) for the reduction in RBC transfusion in the studies including only patients with MELD score 25 or less while there was no heterogeneity in those studies with specified deceased donors.…”

Section: Discussionmentioning

confidence: 99%

“…Heterogeneity was described as I 2 -test. Mean and standard deviation were estimated for studies 30–33,37,38,42–44 that only reported median and interquartile range using the estimation method proposed by Wan et al , 25,26 to allow for pooling of continuous outcomes.…”

Section: Methodsmentioning

confidence: 99%

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Viscoelastic versus conventional coagulation tests to reduce blood product transfusion in patients undergoing liver transplantation

Aceto

Punzo

Franco

et al. 2022

European Journal of Anaesthesiology

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BACKGROUND Recent literature suggests viscoelastic test (VET)-guided transfusion management could be associated with reduced blood product administration in patients undergoing liver transplantation. OBJECTIVE(S)To assess the effectiveness of coagulation management guided by VETs compared with conventional coagulation tests (CCTs) in reducing blood product transfusion in patients undergoing liver transplantation.DESIGN Systematic review and meta-analysis of randomised (RCTs) and nonrandomised clinical trials performed according to PRISMA guidelines. The protocol was previously published (PROSPERO: CRD42021230213) DATA SOURCES The Cochrane Central Library, PubMed/ MEDLINE, Embase and the Transfusion Evidence Library were searched up to 30 th January 2022.ELIGIBILITY CRITERIA Setting: operating room. Patients: liver transplantation recipients. Intervention: use of VETs versus CCTs. Main outcome measures: the primary outcome was the mean number of transfused units for each blood product including red blood cells (RBCs), fresh frozen plasma (FFP), platelets (PLTs) and cryoprecipitate. Secondary outcomes included mortality rate, intensive care unit (ICU) and hospital length of stay (LOS).RESULTS Seventeen studies (n ¼ 5345 patients), 15 observational and two RCTs, were included in this review. There was a mean difference reduction in RBCs [mean difference: À1.40, 95% confidence interval (95% CI), À1.87 to À0.92; P < 0.001, I 2 ¼ 61%) and FFP units (mean difference: À2.98, 95% CI, À4.61 to À1.35; P ¼ < 0.001; I 2 ¼ 98%) transfused in the VETs group compared with the CCTs one. A greater amount of cryoprecipitate was administered in the VETs group (mean difference: 2.71, 95% CI, 0.84 to 4.58; P ¼ 0.005; I 2 ¼ 91%). There was no significant difference in the mean number of PLT units, mortality, hospital and ICU-LOS.CONCLUSION Our meta-analysis demonstrated that VETs implementation was associated with reduced RBC and FFP consumption in liver transplantation patients without effects on mortality and hospital and ICU-LOS. The certainty of evidence ranged from moderate to very low. Further well conducted RCTs are needed to improve the certainty of evidence.

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Section: Discussionmentioning

confidence: 93%

“…The mean age in 13 studies 29,31–34,36–43 was 53.46 ± 10.55 years and mean MELD score was 22.18 ± 8.74 calculated in 12 studies (Table 1). 29,31–33,36–43 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Viscoelastic versus conventional coagulation tests to reduce blood product transfusion in patients undergoing liver transplantation

Aceto

Punzo

Franco

et al. 2022

European Journal of Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Additionally, Al Moosawi et al suggested that using ROTEM in LT surgery may prevent unnecessary transfusions of FFP for isolated elevated INRs, proving an advantage for coagulation assessment in ESLD patients compared to INR [ 63 ]. In a retrospective observational study by Gaspari et al, a preliminary analysis showed that patients in the TEG group, compared with the SLTs group, received fewer RBCs and blood products.…”

Section: Use Of Viscoelastic Tests Assaysmentioning

confidence: 99%

Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease

et al. 2022

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Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patient population. Despite deranged quantitative and qualitative coagulation laboratory parameters, prophylactic coagulation management is unnecessary for patients who do not bleed. Transfusion of red blood cells (RBCs) and blood products carries independent risks for morbidity and mortality, including modulation of the immune system with increased risk for nosocomial infections. Optimal coagulation management in these complex patients should be based on the analysis of standard coagulation tests (SCTs) and viscoelastic tests (VETs). VETs represent an individualized approach to patients and can provide information about coagulation dynamics in a concise period of time. This narrative review will deliver the pathophysiology of deranged hemostasis in ESLD, explore the difficulties of evaluating the coagulopathies in liver disease patients, and examine the use of VET assays and management of coagulopathy using coagulation factors. Methods: A selective literature search with PubMed as the central database was performed with the following.

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Viscoelastic Monitoring in Liver Transplantation

Malleeswaran¹,

Sivajothi²,

Reddy³

2021

Liver Transpl

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Cirrhosis and liver transplantation (LT) surgery are associated with substantial alterations to the patient's coagulation status. Accurate monitoring of these changes during LT can help manage bleeding proactively and potentially reduce transfusion requirements. Unlike conventional coagulation tests (CCTs), viscoelastic monitoring (VEM) can provide an accurate, realtime, point-of-care assessment of coagulation status during LT and hence has become an invaluable tool for anesthetists and intensive care physicians. However, it remains an enigmatic subject for transplantation surgeons who are more conversant with CCTs. This review discusses the principles of VEM, provides a primer to understanding and interpreting its output, and explains how it can be used to make real-world clinical decisions during LT.

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ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion

Cited by 8 publications

References 33 publications

Viscoelastic versus conventional coagulation tests to reduce blood product transfusion in patients undergoing liver transplantation

Viscoelastic versus conventional coagulation tests to reduce blood product transfusion in patients undergoing liver transplantation

Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease

Viscoelastic Monitoring in Liver Transplantation

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