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Management of bleeding and transfusion during liver transplantation before and after the introduction of a rotational thromboelastometry–based algorithm
Author(s) -
Roullet Stéphanie,
Freyburger Geneviève,
Cruc Maximilien,
Quinart Alice,
Stecken Laurent,
Audy Magali,
Chiche Laurence,
Sztark François
Publication year - 2015
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24030
Subject(s) - thromboelastometry , medicine , fibrinogen , liver transplantation , prospective cohort study , blood transfusion , coagulation , surgery , blood product , coagulation testing , anesthesia , transplantation
Orthotopic liver transplantation (OLT) remains a potentially hemorrhagic procedure. Rotational thromboelastometry (ROTEM) is a point‐of‐care device used to monitor coagulation during OLT. Whether it allows blood loss and transfusions to be reduced during OLT remains controversial. Excellent correlations and predictive values have been found between ROTEM parameters and fibrinogen. We hypothesized that the use of a ROTEM‐based transfusion algorithm during OLT would lead to more fibrinogen transfusion and decreased bleeding and blood transfusion. Sixty adult patients were consecutively included in a prospective, without‐versus‐with study: 30 in the group without ROTEM results and 30 in the group with the ROTEM‐based algorithm. A small and nonsignificant increase in median fibrinogen transfusions was found for the with group (6.0 g versus 4.5 g, P = 0.50). It was not associated with a decrease in blood transfusions or in the number of patients exposed to blood products. Liver Transpl 21:169‐179, 2015 . © 2014 AASLD.