28 September 2010
The use of thromboelastometry in the assessment of hemostatsis during orthotopic liver transplantation reduces the demand for blood productsJanusz Trzebicki, Edyta Flakiewicz, Maciej Kosieradzki, Beata Blaszczyk, Marcin Kołacz, Lidia Jureczko, Marek Pacholczyk, Andrzej Chmura, Beata Lagiewska, Wojciech Lisik, Dariusz Wasiak, Dariusz Kosson, Artur Kwiatkowski, Tomasz Lazowski
Ann Transplant 2010; 15(3): 19-24 :: ID: 881172
Background: Bleeding due to fibrinolysis is a serious intraoperative complication during orthotopic liver transplantation (OLT). For a number of years aprotinin was used to minimize risk of this complication. This drug was however banned in 2007 and substituted with other antifibrinolytics. The aim of the study was to assess the potential of intraoperative thromboelastometry to evaluate hemostasis and channelize antifibrinolytic therapy.
Material/Methods: Since ban on aprotinin, 39 patients underwent OLT in our center with no monitoring of fibrinolysis (NMF). Severe disturbances of hemostasis assessed clinically only as a need for blood and blood products transfusion and were treated with transfusion of fresh frozen plasma only. In 2008 we started to use thromboelastometry (ROTEM group, n=39), which allowed for targeted treatment of hyperfibrinolysis with tranexamic acid.
Results: The need for blood transfusion in ROTEM group was insignificantly a lower than in NMF group (4.1±4.76 vs 5.53±4.89 units, p=0.2). Patients from ROTEM group required also less plasma transfusions (10.01±7.47 vs 13.15±6.62, p=0.06). Severe fibrinolysis was found in 3 patients from ROTEM group (7.7%) and was treated with tranexamic acid.
Conclusions: Thromboelastometry provides an immediate diagnosis of fibrinolysis, justifies implementation of targeted treatment and confirms effectiveness of the therapy. In a larger study group it can also result in significant minimization of blood products transfusion during OLT.
Keywords: Aprotinin, Blood Transfusion, Fibrinolysis, Liver Transplantation, thromboelastometry
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