Thromboelastography with heparinase in orthotopic liver transplantation.
OBJECTIVE
To investigate the role of heparin in the postreperfusion coagulopathy during liver transplantation with heparinase-guided thromboelastography.


METHODS
A prospective, interventional study.


METHODS
A university-affiliated hospital.


METHODS
Twenty-six patients undergoing orthotopic liver transplantation (OLT).


METHODS
Blood drawn at five intervals for thromboelastography assessment with native (12 patients) or celite blood (14 patients) compared with simultaneous thromboelastography traces with added heparinase.


RESULTS
In the native samples, the prolonged R (reaction) and K (coagulation) time and decreased alpha angle were corrected in heparinase thromboelastograph traces immediately before reperfusion and 10 minutes postreperfusion. In the celite-accelerated samples, the heparinase traces showed correction of the R and K times and alpha angle only at the 10-minute postreperfusion stage. In seven patients who had thromboelastography performed after protamine administration, there were no differences between celite and heparinase-celite traces.


CONCLUSIONS
Heparinase-treated thromboelastography offered compelling evidence for the presence of heparin-like activity after liver graft reperfusion. The objective evidence provided by this modification of thromboelastography-guided protamine administration and was useful in identifying one of the many potential causes of postreperfusion bleeding in patients undergoing OLT.
Pivalizza
E G
EG
Department of Anesthesiology, University of Texas Health Science Center, Houston 77030, USA.
Abramson
D C
DC
King
F S
FS
D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000502:physiology; D006494:Heparin Antagonists / Q000008:administration & dosage; D019763:Heparin Lyase / Q000008:administration & dosage*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage; D013916:Thrombelastography
D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin; D019763:Heparin Lyase