title: Perioperative thrombotic complications in liver transplantation.
abstract: Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation (OLT), the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival. Thromboembolism during OLT is characterized not only by a complex aetiology, but also by unpredictable onset and evolution of the disease. The initiation of a procoagulant process may be triggered by various factors, such as inflammation, venous stasis, ischemia-reperfusion injury, vascular clamping, anatomical and technical abnormalities, genetic factors, deficiency of profibrinolytic activity, and platelet activation. The involvement of the arterial system, intracardiac thrombosis, pulmonary emboli, portal vein thrombosis, and deep vein thrombosis, are among the most serious thrombotic events in the perioperative period. The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis, particularly when these events occur intraoperatively or early after OLT. Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting, many institutions recommend such an approach especially in the subset of patients at high risk. However, the decision of when, how and in what doses to use the various chemical anticoagulants is still a difficult task, since there is no common consensus, even for high-risk cases. The risk of postoperative thromboembolism causing severe hemodynamic events, or even loss of graft function, must be weighed and compared with the risk of an important bleeding. In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurring in the perioperative period, as well as their incidence and clinical features. Moreover, the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.
authors.affiliation: Paolo Feltracco, Stefania Barbieri, Carlo Ori, Department of Medicine, UO Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.affiliation: Paolo Feltracco, Stefania Barbieri, Carlo Ori, Department of Medicine, UO Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Barbieri
authors.affiliation: Paolo Feltracco, Stefania Barbieri, Carlo Ori, Department of Medicine, UO Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.affiliation: Paolo Feltracco, Stefania Barbieri, Carlo Ori, Department of Medicine, UO Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.affiliation: Paolo Feltracco, Stefania Barbieri, Carlo Ori, Department of Medicine, UO Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.affiliation: Paolo Feltracco, Stefania Barbieri, Carlo Ori, Department of Medicine, UO Anaesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Hepatic artery occlusion; Liver transplantation; Postoperative complications; Pulmonary emboli; Thromboembolic phenomena; Vascular complications