Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography.
Using both conventional laboratory clotting profile and thrombelastography, coagulation status was monitored intraoperatively during liver transplantation in the first 75 cases performed at the Austin Hospital between June 1988 and October 1992. Superimposed on a baseline coagulopathy due to liver disease is a specific pattern of coagulation disturbance which occurs during a liver transplant. Fibrinolysis occurs in the anhepatic stage, worsens with early reperfusion and then spontaneously resolves. In addition reperfusion is associated with a transient clotting defect. If blood loss is excessive, coagulopathy due to massive transfusion may compound the situation. Thrombelastography is a measurement technique allowing rapid on-site assessment of functional clotting status. It is particularly useful in liver transplant surgery. In combination with clinical bleeding assessment it facilitates selective use of component therapy (fresh frozen plasma, platelets and cryoprecipitate) and specific drug treatment only when it is appropriate. It also acts as a liver function test, being especially useful in assessing the graft after reperfusion.
McNicol
P L
PL
Department of Anaesthesia, Austin Hospital, Melbourne, Victoria.
Liu
G
G
Harley
I D
ID
McCall
P R
PR
Przybylowski
G M
GM
Bowkett
J
J
Angus
P W
PW
Hardy
K J
KJ
Jones
R M
RM
D001777:Blood Coagulation / Q000502:physiology; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology; D016343:Monitoring, Intraoperative; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011516:Prothrombin / Q000032:analysis; D015424:Reperfusion / Q000009:adverse effects; D012712:Serum Globulins / Q000032:analysis; D013916:Thrombelastography; D065227:Transfusion Reaction
D005338:Fibrin Fibrinogen Degradation Products; D012712:Serum Globulins; C036309:fibrin fragment D; D011516:Prothrombin; D005340:Fibrinogen