Abstract
BackgroundPerioperative bleeding and transfusion are important causes of morbidity and mortality in patients undergoing liver transplantation. The aim of this study is to assess whether viscoelastic tests-guided therapy with the use of synthetic factor concentrates impact transfusion rates of hemocomponents in adult patients undergoing liver transplantation.MethodsThis is an interventional before-after comparative study. Patients undergoing liver transplantation before the implementation of a protocol using thromboelastometry and synthetic factor concentrates were compared to patients after the implementation. Primary outcome was transfusion of any hemocomponents. Secondary outcomes included: transfusion of red blood cells (RBC), fresh frozen plasma (FFP), cryoprecipitate or platelets, clinical complications, length of stay and in-hospital mortality.ResultsA total of 183 patients were included in the control and 54 in the intervention phase. After propensity score matching, the proportion of patients receiving any transfusion of hemocomponents was lower in the intervention phase (37.0 vs 58.4%; OR, 0.42; 95% CI, 0.20–0.87; p = 0.019). Patients in the intervention phase received less RBC (30.2 vs 52.5%; OR, 0.21; 95% CI, 0.08–0.56; p = 0.002) and FFP (5.7 vs 27.3%; OR, 0.11; 95% CI, 0.03–0.43; p = 0.002). There was no difference regarding transfusion of cryoprecipitate and platelets, complications related to the procedure, hospital length of stay and mortality.ConclusionsUse of a viscoelastic test-guided transfusion algorithm with the use of synthetic factor concentrates reduces the transfusion rates of allogenic blood in patients submitted to liver transplantation.Trial registrationThis trial was registered retrospectively on November 15th, 2018 – clinicaltrials.gov – Identifier: NCT03756948.
Highlights
Perioperative bleeding is one of the most important causes of morbidity and mortality in liver transplantation [1]
Patients with advanced liver diseases present with changes in coagulation and hemostasis, including an elevated international normalized ratio (INR), decreased levels of fibrinogen and a decreased platelet count, and these abnormal values suggest a state of hypocoagulability [16]
Thrombin generating capacity is normal or even increased in this group of patients when compared to healthy controls [17, 18], and the platelets are qualitatively capable of withstanding adequate thrombin generation when their total count is around 50–60 × 109/l [19]
Summary
Perioperative bleeding is one of the most important causes of morbidity and mortality in liver transplantation [1]. Patients with advanced liver diseases present with changes in coagulation and hemostasis, including an elevated international normalized ratio (INR), decreased levels of fibrinogen and a decreased platelet count, and these abnormal values suggest a state of hypocoagulability [16]. Other features of a hypercoagulable profile include increased von Willebrand factor levels, high amounts of procoagulant platelet-derived microparticles and a hypofibrinolytic state [20]. Perioperative bleeding and transfusion are important causes of morbidity and mortality in patients undergoing liver transplantation. The aim of this study is to assess whether viscoelastic tests-guided therapy with the use of synthetic factor concentrates impact transfusion rates of hemocomponents in adult patients undergoing liver transplantation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
