title: Laboratory monitoring of the haemostatic system changes during orthotopic liver transplantation.
abstract: BACKGROUND
  In liver diseases, all components of the haemostatic system are changed and the degree of dysfunction is proportional to hepatocellular damage. During the liver transplantation, values of haemostatic parameters show substantial changes, while postoperatively there is a gradual normalisation of the haemostatic system function.
  
  
  OBJECTIVE
  The aim was to monitor the changes of the haemostatic system intraoperatively and postoperatively, including the dynamics at which physiological values of parameters are reached after transplantation.
  
  
  METHODS
  There were 17 cadaveric transplantations performed at the Clinical Centre of Vojvodina in the period from June 2008 to February 2012. The following parameters were tested: platelets, activated partial thromboplastin, prothrombin and thrombin time, fibrinogen, euglobulin clot lysis time, D-dimer, antithrombin and heparinemia.The results were presented intraoperatively in phases of transplantation, and postoperatively from day 1 to day 7, ending with postoperative day 14.
  
  
  RESULTS
  During transplantation, the most pronounced disorders among those observed are: thrombocytopenia (96 +/- 66.1 x 10(9)/L), prolonged activated partial thromboplastin (1.80 +/- 0.8 R), prothrombin (1.59 +/- 0.4 R) and thrombin time (2.03 +/- 1.7 R), hypofibrinogenemia (2.13 +/- 0.5 g/L), hyperfibrinolysis (29 +/- 12.0 min), increase of D-dimer (1393 +/- 1220.4 ng/mL) and decrease of antithrombin (61 +/- 18.0%). Further monitoring after transplantation from postoperative day 1 revealed a gradual normalisation in the values, reaching physiological values for all parameters on postoperative day 14, except for the sustained high value of D-dimer (2606 +/-1055.1 ng/mL). Heparinemia was within the prophylactic range (0.26 +/- 0 IU/mL).
  
  
  CONCLUSIONS
  Thorough monitoring of the haemostatic system parameters in liver transplantations is of great importance, as it enables the use of optimal substitution therapy during and after transplantation, as well as an adequate postoperative thromboprophylaxis. Our study has shown normalisation of investigated laboratory parameters within 7-14 days after transplantation.
authors.affiliation: Department of Thrombosis, Haemostasis and Haematology Diagnostics, Centre of Laboratory Medicine, Novi Sad, Clinical Centre of Vojvodina, Serbia. sanucin@yahoo.com
authors.forename: Sladjana
authors.initials: S
authors.lastname: Novaković-Anucin
authors.affiliation: Department of Thrombosis, Haemostasis and Haematology Diagnostics, Centre of Laboratory Medicine, Novi Sad, Clinical Centre of Vojvodina, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Gnip
authors.affiliation: Department of Thrombosis, Haemostasis and Haematology Diagnostics, Centre of Laboratory Medicine, Novi Sad, Clinical Centre of Vojvodina, Serbia.
authors.forename: Visnja
authors.initials: V
authors.lastname: Canak
authors.affiliation: Department of Thrombosis, Haemostasis and Haematology Diagnostics, Centre of Laboratory Medicine, Novi Sad, Clinical Centre of Vojvodina, Serbia.
authors.forename: Djurdjina
authors.initials: D
authors.lastname: Jurisić
authors.affiliation: Department of Thrombosis, Haemostasis and Haematology Diagnostics, Centre of Laboratory Medicine, Novi Sad, Clinical Centre of Vojvodina, Serbia.
authors.forename: Pavica
authors.initials: P
authors.lastname: Radović
authors.affiliation: Clinic of Anesthesiology and Intensive Therapy, Clinical Centre of Vojvodina, Novi Sad, Serbia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Erdeljan
authors.affiliation: Clinic of Abdominal, Endocrine and Transplantation Surgery, Clinical Centre of Vojvodina, Novi Sad, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Milosević
authors.affiliation: Department of Thrombosis, Haemostasis and Haematology Diagnostics, Centre of Laboratory Medicine, Novi Sad, Clinical Centre of Vojvodina, Serbia.
authors.forename: Gorana
authors.initials: G
authors.lastname: Mitić
mesh_terms: D000328:Adult; D019774:Blood Coagulation Factor Inhibitors / Q000378:metabolism*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006403:Hematologic Tests; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D013997:Time Factors
chemical_list: D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors