Thromboelastography-Guided Transfusion Decreases Intraoperative Blood Transfusion During Orthotopic Liver Transplantation: Randomized Clinical Trial

Wang, Shen-Chih; Shieh, Ju-Sheng; Chang, Kuang-Yi; Chu, Ya Chun; Liu, C.-S.; Loong, Che‐Chuan; Chan, Kwok-Hon; Mandell, S; Tsou, Mei-Yung

doi:10.1016/j.transproceed.2010.05.144

Cited by 296 publications

(254 citation statements)

References 26 publications

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“…Although data from clinical trials are lacking, these tests are widely used in the setting of liver transplantation to manage major hemorrhage or to trigger blood transfusion. Even in this setting, the threshold values of ROTEM/TEG parameters for triggering transfusion of hemostatic agents (such as fresh frozen plasma), remains to be determined [27], even though in a randomized study significantly fewer units of fresh frozen plasma (FFP) or blood were needed at the time of liver transplantation in patients monitored by TEG [28]. These promising results warrant larger confirmatory studies.…”

Section: Thromboelastometry/thromboelastographymentioning

confidence: 99%

“…The majority of studies that assessed the risk of bleeding in relation to platelet count and/or results of coagulation tests in patients with cirrhosis undergoing invasive procedures or surgery were retrospective, and adopted a priori cut-offs for laboratory values (Table 1) [13,19,28,. In one study with a stringent inclusion criterion for platelet counts of >50 × 10 9 /L, a platelet count of ≤60 × 10 9 /L was identified as a risk factor for bleeding after percutaneous liver biopsy [13].…”

Section: Risk Of Bleeding Following Invasive Procedures or Surgerymentioning

confidence: 99%

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Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Section: Thromboelastometry/thromboelastographymentioning

confidence: 99%

Section: Risk Of Bleeding Following Invasive Procedures or Surgerymentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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“…9 Any coagulation abnormality must be corrected with blood components and we find thromboelastography very useful to direct the use of blood components. 10 After reperfusion of liver and achieving haemostasis, arterial anastomosis is performed (Figure 4). At our centre anastomosis is done using loupes with 3.5× magnification.…”

Section: Vascular Complicationsmentioning

confidence: 99%

“…Ensuring integrity of the blood supply to the biliary tree, transecting the bile ducts along with the hilar plate and refinement in techniques of biliary anastomosis in LDLT has resulted in a significant reduction in the incidence of biliary complications from 24.3-40.6% before 2007 to 5. [3][4][5][6][7][8][9][10][11][12].8% in studies published after 2008 (Table 6). [27][28][29][30][31][32][33][34] Overall biliary complications in LDLT in our series was seen in three recipients (16.6%) which compares well with other studies.…”

Section: Biliary Complicationsmentioning

confidence: 99%

Liver transplantation in Indian Armed Forces—initial experience

Saha

Naidu

Ramesh

et al. 2012

Medical Journal Armed Forces India

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“…In the same shift of concept, liver transplant patients were paradoxically found to have a procoagulant state in the setting of an elevated INR, as well as lower rates of portal vein thrombosis and improved survival without the development of hemorrhagic complications in patients with decompensated liver disease treated with enoxaparin [19,20]. …”

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K. The effectiveness of these treatments is estimated by international normalized ratio (INR), an imprecise measure of coagulation in the setting of cirrhosis. Transfusion with FFP may lead to detrimental side effects, including worsening volume overload and increased portal hypertension. We present a case of a 60-year-old patient intubated for acute hypoxic respiratory failure secondary to volume overload who subsequently developed bilateral pneumothoraces, requiring immediate chest tube placement. In this case, the patient had ongoing hepatic decompensation with volume overload and acute worsening of coagulopathy with an INR of 4.2. In this setting, 4-Factor Prothrombin Complex Concentrate (4F-PCC) was chosen to correct coagulation parameters with a low infusion volume. One hour following administration, INR was 1.5. Chest tubes were placed bilaterally and oxygenation improved without bleeding complications. While the data is still lacking, 4F-PCC may be considered for urgent and emergency situations in cirrhotic patients.

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Thromboelastography-Guided Transfusion Decreases Intraoperative Blood Transfusion During Orthotopic Liver Transplantation: Randomized Clinical Trial

Cited by 296 publications

References 26 publications

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Liver transplantation in Indian Armed Forces—initial experience

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

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