title: The use of thromboelastometry in the assessment of hemostasis during orthotopic liver transplantation reduces the demand for blood products.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Intensive Care, The Medical University of Warsaw, Poland. jtrzebicki@gmail.com
authors.forename: Janusz
authors.initials: J
authors.lastname: Trzebicki
authors.forename: Edyta
authors.initials: E
authors.lastname: Flakiewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Kosieradzki
authors.forename: Beata
authors.initials: B
authors.lastname: Blaszczyk
authors.forename: Marcin
authors.initials: M
authors.lastname: Kołacz
authors.forename: Lidia
authors.initials: L
authors.lastname: Jureczko
authors.forename: Marek
authors.initials: M
authors.lastname: Pacholczyk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
authors.forename: Beata
authors.initials: B
authors.lastname: Lagiewska
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lisik
authors.forename: Dariusz
authors.initials: D
authors.lastname: Wasiak
authors.forename: Dariusz
authors.initials: D
authors.lastname: Kosson
authors.forename: Artur
authors.initials: A
authors.lastname: Kwiatkowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Lazowski
mesh_terms: 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
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin