The use of a thromboelastometry-based algorithm reduces the need for blood product transfusion during orthotopic liver transplantation

Bonnet, A.; Gilquin, Nathalie; Steer, Nadia; Genête, Mathieu; Quattrone, Diego; Pradat, Pierre; Maynard, Marianne; Mabrut, Jean‐Yves; Aubrun, Frédéric

doi:10.1097/eja.0000000000001084

Cited by 50 publications

(68 citation statements)

References 31 publications

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“…These studies indicate that VET‐guided therapy seems to contribute to the decreased needs for and amounts of PRBC and FFP transfusions. Notably, several nonrandomized studies found an increased indication for fibrinogen (cryoprecipitate) and PLT transfusions, which is similar to the findings from the most recent randomized clinical trial 12 …”

Section: Vets In Ltsupporting

confidence: 77%

“…In both groups, PRBCs were transfused if Hb < 9 g/dL. 12 This protocol, although complex, takes some clinical contexts into account.…”

Section: Rotem Algorithmmentioning

confidence: 99%

“…They found that the TEG group had reduced usage of FFP (mean [±SD], 12.8 [±7.0] units vs 21.5 [±12.7] units) and a trend toward less blood loss without any difference in total fluid administration and 3‐year survival. In 2019, Bonnet and associates 12 from Lyon, France, reported a trial on 81 adult LT patients who were randomized to ROTEM‐directed coagulation management vs an SLT‐based one. Median [interquartile range] intraoperative overall transfusion requirements were reduced in the ROTEM group (3 [2–4] vs 7 [4–10] units, P = .005).…”

Section: Vets In Ltmentioning

confidence: 99%

“…For the SLT group, fibrinogen 3 g if fibrinogen < 1 g/dL; PLT concentrate if PLTs < 50 × 10 9 /L before transfusion, at anhepatic phase, or in case of bleeding, if PLTs < 30 × 10 9 /L at the vascular unclamping time at the end of intervention or without bleeding; 2 units of FFP if prothrombin < 40% before transfusion at anhepatic phase, or in case of bleeding, if prothrombin <30% at the vascular unclamping time at the end of intervention or without bleeding; and bolus tranexamic acid 1 to 3 g every 24 hours in case of fibrin degradation products. In both groups, PRBCs were transfused if Hb < 9 g/dL 12 . This protocol, although complex, takes some clinical contexts into account.…”

Section: Vets In Ltmentioning

confidence: 99%

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Viscoelastic testing in liver transplantation

Sakai

2020

Transfusion

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Despite the lack of large randomized clinical studies, viscoelastic tests (VETs) have been a critical armamentarium for hemostatic control in liver transplantation (LT) since the 1960s. Many transplant institutions have adopted VETs in their clinical practice. Several small‐size randomized clinical trials on LT patients have suggested that VET‐guided hemostatic treatment algorithms have led to decreased indications for and amounts of transfused blood products, especially fresh‐frozen plasma, compared to standard laboratory‐based hemostatic management. VETs have also been reported to offer insight into the diagnosis and prediction of LT patients' development of hypercoagulability‐related morbidity and mortality. There is still a need for VET device–specific hemostatic algorithms in LT, and clinicians must take into account the tendency to underestimate the coagulation capacity of VETs in patients with end‐stage liver disease where hemostasis is rebalanced.

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Section: Vets In Ltsupporting

confidence: 77%

“…In both groups, PRBCs were transfused if Hb < 9 g/dL. 12 This protocol, although complex, takes some clinical contexts into account.…”

Section: Rotem Algorithmmentioning

confidence: 99%

Section: Vets In Ltmentioning

confidence: 99%

Section: Vets In Ltmentioning

confidence: 99%

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Viscoelastic testing in liver transplantation

Sakai

2020

Transfusion

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“…ROTEM has been very useful monitoring hemostasis and guiding transfusion requirements. 18 Cochrane review published in 2018 showed that the use of ROTEM intraoperatively and postoperatively in cardiac surgery to guide transfusion of blood products seems to reduce mortality. 19 Traditional conventional tests are poor predictor of bleeding, failing in guide transfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

Thromboelastometry early identifies thrombotic complications related to COVID-19: A case report

Martin

Crochemore

Savioli

et al. 2021

SAGE Open Medical Case Reports

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COVID-19 is a contagious infectious disease, which quickly spreads worldwide, whose clinical presentation includes from mild flu-like symptoms to pneumonia and severe acute respiratory syndrome. The severe presentation of the disease can affect different organs and systems. Coagulopathy has been associated with a worse clinical outcome, with manifestations such as pulmonary embolism and systemic arterial thrombosis. Thromboelastometry has been used to identify hypercoagulability in early stages of disease. We report the case of a 59-year-old woman with COVID-19 infection complicated by pulmonary embolism and acute arterial thrombosis associated with critical lower limb ischemia requiring amputation. This report showed a case of thrombotic complication in patient with infection caused by novel coronavirus 2019 whose thromboelastometry allowed the early identification of hypercoagulability pattern. This is a single case report and the use of thromboelastometry should be further evaluated in large prospective cohort studies.

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Coagulopathy and hemostasis management in patients undergoing liver transplantation

Pillai

Kriss

Al‐Adra

et al. 2022

Liver Transplantation

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Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies Anjana A. Pillai and Michael Kriss contributed equally to this study and share co-first authorship.Constantine J. Karvellas and Nicolas Intagliata contributed equally to this study and share co-senior authorship.

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The use of a thromboelastometry-based algorithm reduces the need for blood product transfusion during orthotopic liver transplantation

Cited by 50 publications

References 31 publications

Viscoelastic testing in liver transplantation

Viscoelastic testing in liver transplantation

Thromboelastometry early identifies thrombotic complications related to COVID-19: A case report

Coagulopathy and hemostasis management in patients undergoing liver transplantation

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