Use of higher thromboelastogram transfusion values is not associated with greater blood loss in liver transplant surgery.
Plasma-containing products are given during the pre-anhepatic stage of liver transplant surgery to correct abnormal thromboelastogram (TEG) values and prevent blood loss due to coagulation defects. However, evidence suggests that abnormal TEG results do not always predict bleeding. We questioned what effect using higher TEG values to initiate treatment would have on blood loss. A single transfusion protocol was used for all patients who underwent liver transplantation between 2007 and 2010. Thirty-eight patients received coagulation products when standard TEG cutoff values were exceeded, whereas another 39 patients received coagulation products when the TEG values were 35% greater than normal. The results of postoperative coagulation tests for total blood loss and the use of blood products were compared for the 2 groups. When the critical TEG values for transfusion were higher, significantly fewer units of fresh frozen plasma (5.58 ± 6.49 versus 11.53 ± 6.66 U) and pheresis platelets (1.84 ± 1.33 versus 3.55 ± 1.43 U) were used. There were no differences in blood loss or postoperative blood product use. In conclusion, the use of higher critical TEG values to initiate the transfusion of plasma-containing products is not associated with increased blood loss. Further testing is necessary to identify what TEG value predicts bleeding due to a deficit in coagulation factors.
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Shen-Chih
SC
Wang
Ho-Tien
HT
Lin
Kuang-Yi
KY
Chang
M Susan
MS
Mandell
Chien-Kun
CK
Ting
Ya-Chun
YC
Chu
Che-Chuan
CC
Loong
Kwok-Hon
KH
Chan
Mei-Yung
MY
Tsou
D000328:Adult; D001777:Blood Coagulation; D001779:Blood Coagulation Factors; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods* / Q000592:standards
D001779:Blood Coagulation Factors