The use of thromboelastometry in the assessment of hemostasis during orthotopic liver transplantation reduces the demand for blood products.
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.


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.
Trzebicki
Janusz
J
Department of Anesthesiology and Intensive Care, The Medical University of Warsaw, Poland. jtrzebicki@gmail.com
Flakiewicz
Edyta
E
Kosieradzki
Maciej
M
Blaszczyk
Beata
B
Kołacz
Marcin
M
Jureczko
Lidia
L
Pacholczyk
Marek
M
Chmura
Andrzej
A
Lagiewska
Beata
B
Lisik
Wojciech
W
Wasiak
Dariusz
D
Kosson
Dariusz
D
Kwiatkowski
Artur
A
Lazowski
Tomasz
T
D000328:Adult; D000933:Antifibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use; D007611:Aprotinin / Q000494:pharmacology / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests / Q000379:methods*; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006470:Hemorrhage / Q000517:prevention & control; D006487:Hemostasis; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects; D014148:Tranexamic Acid / Q000494:pharmacology / Q000627:therapeutic use; D065227:Transfusion Reaction
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin