Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests.
OBJECTIVE
The Thromboelastogram (TEG; Haemoscope Corporation, Niles, IL) and the ROTEM thromboelastometry analyzer (Pentapharm GmbH, Munich, Germany) are coagulation monitors that measure the viscoelastic changes accompanying whole-blood coagulation generation and lysis. It is not clear whether TEG and ROTEM transfusion algorithms suggest similar blood component intervention. This study aims to report the extent to which administration of platelets, fresh frozen plasma, and cryoprecipitate would be indicated using protocol-dictated interventions by the Rotem, TEG, and conventional coagulation screens during orthotopic liver transplantation (OLT).


METHODS
Prospective observational study.


METHODS
University hospital.


METHODS
Twenty patients undergoing orthotopic liver transplantation.


METHODS
Coagulation was managed with native TEG protocols. Additional samples for kaolin TEG, kaolin heparinase TEG, Rotem in-TEM, Rotem hep-TEM, Rotem fib-TEM, full blood count, prothrombin time, and Clauss fibrinogen assays were taken at 5 fixed operative stages.


RESULTS
Results were reviewed and protocol-indicated interventions recorded. There was moderate agreement between Clauss fibrinogen and Rotem fib-TEM assays about fulfilling fibrinogen transfusion criteria (kappa = 0.42, p < or = 0.05). Agreement between TEG and Rotem to transfuse platelets was fair (Rotem in-TEM/native heparinase TEG, kappa = 0.33, Rotem in-TEM/kaolin heparinase TEG, kappa = 0.28). There was moderate agreement between Rotem in-TEM and prothrombin time (kappa = 0.42), and poor agreement between other tests about the point to administer fresh frozen plasma.


CONCLUSIONS
Transfusion practice is likely to differ according to the method of coagulation monitoring used. A prospective case-matched study using the viscoelastic tests used in this study would be beneficial in determining the optimal therapy. Rotem fib-TEM monitoring may improve hemostasis management.
Coakley
Margaret
M
Department of Anaesthesia, Royal Free Hospital, London, United Kingdom. mcoakley@doctors.org.uk
Reddy
Kalpana
K
Mackie
Ian
I
Mallett
Susan
S
D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D005340:Fibrinogen / Q000008:administration & dosage; D006801:Humans; D016031:Liver Transplantation; D010949:Plasma; D010952:Plasma Substitutes; D017713:Platelet Transfusion; D013916:Thrombelastography / Q000295:instrumentation* / Q000379:methods
D010952:Plasma Substitutes; D005340:Fibrinogen