Hemostasis and coagulation monitoring and management during liver transplantation.
OBJECTIVE
The objective of this review is to evaluate the present state of nonpharmacological measures, pharmacological measures applied to reduce bleeding and perioperative blood products management during orthotopic liver transplantation.


RESULTS
Recent studies improve the knowledge in the hemostatic response in cirrhotic patients such as thrombin generation and platelet adhesion due to elevated levels of von Willebrand factor. Restrictive fluid therapy is an important measure to avoid hemodilution and so bleeding. Prophylaxis with antifibrinolytics is being questioned for the risk of thrombosis. Correction of coagulation defects with fresh frozen plasma has not reduced blood loss, and it has been related to worse outcome. Also, platelets administration has a negative effect in the outcome.


CONCLUSIONS
In order to maintain hemostatic system in compensated cirrhotic patient, every effort we do to improve it must consider not to imbalance it resulting in thrombi-hemorrhagic events. Pharmacological measures must be based on their clinical evidence. Identification of high risk bleeding patients would help in developing coagulation guidelines.
Dalmau
Antònia
A
Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelone, Barcelona, Spain. madalmau@bellvitgehospital.cat
Sabaté
Antoni
A
Aparicio
Idoia
I
D000925:Anticoagulants / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016903:Drug Monitoring; D005343:Fibrinolytic Agents / Q000009:adverse effects; D005440:Fluid Therapy / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D017713:Platelet Transfusion / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013927:Thrombosis / Q000139:chemically induced / Q000517:prevention & control
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005343:Fibrinolytic Agents