title: Reduced Transfusion During OLT by POC Coagulation Management and TEG Functional Fibrinogen: A Retrospective Observational Study.
abstract: Patients undergoing orthotopic liver transplantation are at high risk of bleeding complications. Several Authors have shown that thromboelastography (TEG)-based coagulation management and the administration of fibrinogen concentrate reduce the need for blood transfusion.
  
  
  METHODS
  We conducted a single-center, retrospective cohort observational study (Modena Polyclinic, Italy) on 386 consecutive patients undergoing liver transplantation. We assessed the impact on resource consumption and patient survival after the introduction of a new TEG-based transfusion algorithm, requiring also the introduction of the fibrinogen functional thromboelastography test and a maximum amplitude of functional fibrinogen thromboelastography transfusion cutoff (7 mm) to direct in administering fibrinogen (2012-2014, n = 118) compared with a purely TEG-based algorithm previously used (2005-2011, n = 268).
  
  
  RESULTS
  After 2012, there was a significant decrease in the use of homologous blood (1502 ± 1376 vs 794 ± 717 mL, P < 0.001), fresh frozen plasma (537 ± 798 vs 98 ± 375 mL, P < 0.001), and platelets (158 ± 280 vs 75 ± 148 mL, P < 0.005), whereas the use of fibrinogen increased (0.1 ± 0.5 vs 1.4 ± 1.8 g, P < 0.001). There were no significant differences in 30-day and 6-month survival between the 2 groups.
  
  
  CONCLUSIONS
  The implementation of a new coagulation management method featuring the addition of the fibrinogen functional thromboelastography test to the TEG test according to an algorithm which provides for the administration of fibrinogen has helped in reducing the need for transfusion in patients undergoing liver transplantation with no impact on their survival.
authors: Division of Anaesthesiology and Intensive Care Unit, Department of Surgery, Azienda Ospedaliero-Universitaria of Modena, Policlinico, Modena, Italy.
authors: Lesley
authors: L
authors: De Pietri
authors: Division of Anaesthesiology and Intensive Care Unit, Department of Surgery, Azienda Ospedaliero-Universitaria of Modena, Policlinico, Modena, Italy.
authors: Francesca
authors: F
authors: Ragusa
authors: Division of Anaesthesiology and Intensive Care Unit, Department of Surgery, Azienda Ospedaliero-Universitaria of Modena, Policlinico, Modena, Italy.
authors: Annalisa
authors: A
authors: Deleuterio
authors: Division of Anaesthesiology and Intensive Care Unit, Department of Surgery, Azienda Ospedaliero-Universitaria of Modena, Policlinico, Modena, Italy.
authors: Bruno
authors: B
authors: Begliomini
authors: Liver and Multivisceral Transplant Center, Azienda Ospedaliero-Universitaria of Modena, Policlinico, Modena, Italy.
authors: Valentina
authors: V
authors: Serra