title: Is Hydroxyethyl Starch Irrelevant to Hemostasis in Patients Undergoing Liver Transplantation?--In vitro Analysis Based on Thromboelastometry.
abstract: BACKGROUND
  Liver transplantation may be associated with severe bleeding that requires intensive fluid management. Aggressive fluid administration could result in hemodilution, triggering dilutional coagulopathy that intensifies bleeding. Colloids are plasma expanders used in daily practice. Fibrinogen, malfunctioning in liver cirrhosis, is the earliest decreasing clotting factor while bleeding. Fibrinogen supplementation is recommended as the first-choice therapy in such cases. Therefore, the influence of hemodilution on fibrin clot formation among patients with liver cirrhosis was analyzed, followed by the assessment of fibrinogen supplementation in clot restitution.
  
  
  METHODS
  Blood collected from 22 patients with post-inflammatory liver cirrhosis was diluted up to 30% and 60% with crystalloid (0.9% NaCl) or colloid (6% hydroxyethyl starch 130/0.4), followed by fibrinogen supplementation corresponding to an overall dose of 4 g. The influence of hemodilution on plasma fibrinogen concentration and on thromboelastometry FIBTEM test was analyzed, as well as the influence of fibrinogen supplementation.
  
  
  RESULTS
  Hemodilution lowers fibrinogen concentration and decreases fibrin clot formation. The higher the grade of dilution, the more profound the disturbances observed; 6% hydroxyethyl starch 130/0.4 cause more intense effect on fibrin clot formation than 0.9% NaCl. Fibrinogen supplementation improves fibrin clot formation as assessed in FIBTEM.
  
  
  CONCLUSIONS
  Fibrinogen supplementation among patients with liver cirrhosis might improve fibrin clot formation during hemodilution. Fibrinogen supplementation might by considered as a possible treatment of coagulopathy during liver transplantation, but further clinical studies need to be performed.
authors.affiliation: I Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nicińska
authors.affiliation: I Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Pluta
authors.affiliation: I Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kołacz
authors.affiliation: Department of General and Transplantation Surgery, Medical Uniwersity of Warsaw, Warsaw, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Łągiewska
authors.affiliation: Department of General and Transplantation Surgery, Medical Uniwersity of Warsaw, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lisik
authors.affiliation: Department of General and Transplantation Surgery, Medical Uniwersity of Warsaw, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
authors.affiliation: I Department of Anaesthesiology and Intensive Care, Medical Uniwersity of Warsaw, Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Trzebicki
mesh_terms: D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006438:Hemodilution / Q000379:methods; D006487:Hemostasis / Q000187:drug effects; D006489:Hemostatic Techniques; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D066298:In Vitro Techniques; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013916:Thrombelastography / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D005340:Fibrinogen