title: Management of bleeding and transfusion during liver transplantation before and after the introduction of a rotational thromboelastometry-based algorithm.
abstract: Orthotopic liver transplantation (OLT) remains a potentially hemorrhagic procedure. Rotational thromboelastometry (ROTEM) is a point-of-care device used to monitor coagulation during OLT. Whether it allows blood loss and transfusions to be reduced during OLT remains controversial. Excellent correlations and predictive values have been found between ROTEM parameters and fibrinogen. We hypothesized that the use of a ROTEM-based transfusion algorithm during OLT would lead to more fibrinogen transfusion and decreased bleeding and blood transfusion. Sixty adult patients were consecutively included in a prospective, without-versus-with study: 30 in the group without ROTEM results and 30 in the group with the ROTEM-based algorithm. A small and nonsignificant increase in median fibrinogen transfusions was found for the with group (6.0 g versus 4.5 g, P = 0.50). It was not associated with a decrease in blood transfusions or in the number of patients exposed to blood products.
authors.affiliation: Anesthesia and Intensive care Department I, Bordeaux, France; Liver Transplant Unit, Bordeaux, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Roullet
authors.forename: Geneviève
authors.initials: G
authors.lastname: Freyburger
authors.forename: Maximilien
authors.initials: M
authors.lastname: Cruc
authors.forename: Alice
authors.initials: A
authors.lastname: Quinart
authors.forename: Laurent
authors.initials: L
authors.lastname: Stecken
authors.forename: Magali
authors.initials: M
authors.lastname: Audy
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.forename: François
authors.initials: F
authors.lastname: Sztark
mesh_terms: D000465:Algorithms; D001803:Blood Transfusion; D005260:Female; D005340:Fibrinogen / Q000737:chemistry; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D017713:Platelet Transfusion; D011446:Prospective Studies; D012372:ROC Curve; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005340:Fibrinogen