title: Vitamin K antagonist therapy and liver transplantation: two cases managed without normalizing the international normalized ratio.
abstract: Guidelines for surgery in patients treated with vitamin K antagonist recommends to correct international normalized ratio (INR), although they do not focus on liver transplantation candidates. We report two patients treated with vitamin K antagonist, monitored by thromboelastometry during liver transplantation. Case 1: basal INR was 3.15. Extem coagulation time was 83 s and maxim clot firmness was 60 mm. The surgical procedure did not show bleeding. Two red blood cells were transfused and no other blood products were administered. Last INR was 3.17. Case 2: basal INR was 2.79. A thrombocytopenia of 58 000/mm was detected. Extem coagulation time was 176 s, and maxim clot firmness was 40 mm. Fibtem maxim clot firmness was 11 mm. The surgical procedure did not show bleeding. No blood product was administered. Last INR was 2.1. Although thromboelastometry did not correlate with INR, monitoring of the coagulation using thromboelastometry in combination with surgery helped to conduct hemostatic corrections.
authors.affiliation: Department of Anesthesiology, Hospital Universitari de Bellvitge, Universitat de Barcelona Health Campus, Idibell, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sabate
authors.forename: Laura
authors.initials: L
authors.lastname: Contreras
authors.forename: Idoia
authors.initials: I
authors.lastname: Aparicio
authors.forename: Marta
authors.initials: M
authors.lastname: Costa
authors.forename: Raquel
authors.initials: R
authors.lastname: Reyes
mesh_terms: D001780:Blood Coagulation Tests / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D014812:Vitamin K