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An assessment of thromboelastometry to monitor blood coagulation and guide transfusion support in liver transplantation
Author(s) -
Blasi Annabel,
Beltran Joan,
Pereira Arturo,
MartinezPalli Graciela,
Torrents Abiguei,
Balust Jaume,
Zavala Elizabeth,
Taura Pilar,
GarciaValdecasas JuanCarlos
Publication year - 2012
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2011.03526.x
Subject(s) - thromboelastometry , coagulation , medicine , fibrinogen , coagulopathy , liver transplantation , anesthesia , clotting time , coagulation testing , transplantation , surgery
BACKGROUND: Rotation thromboelastometry (TEM) has been proposed as a convenient alternative to standard coagulation tests in guiding the treatment of coagulopathy during orthotopic liver transplantation (OLT). This study was aimed at assessing the value of TEM in monitoring blood coagulation and guide transfusion support in OLT. STUDY DESIGN AND METHODS: Standard coagulation and TEM (EXTEM and FIBTEM) tests were performed at four preestablished intraoperative time points in 236 OLTs and prospectively recorded in a dedicated database together with the main operative and transfusion data. Transfusion thresholds were based on standard coagulation tests. Spearman's rank correlation (ρ), linear regression, and receiver operating characteristic curves were used when appropriate. RESULTS: EXTEM maximum clot firmness (MCF EXTEM ) was the TEM variable that best correlated with the platelet (PLT) and fibrinogen levels (ρ = 0.62 and ρ = 0.69, respectively). MCF FIBTEM correlated with fibrinogen level (ρ = 0.70). EXTEM clot amplitude at 10 minutes (A10 EXTEM ) was a good linear predictor of MCF EXTEM (R 2 = 0.93). The cutoff values that best predicted the transfusion threshold for PLTs and fibrinogen were A10 EXTEM = 35 mm and A10 FIBTEM = 8 mm. At these values, the negative and positive predictive accuracies of TEM to predict the transfusion thresholds were 95 and 27%, respectively. CONCLUSION: A10 EXTEM is an adequate TEM variable to guide therapeutic decisions during OLT. Patients with A10 EXTEM of greater than 35 mm are unlikely to bleed because of coagulation deficiencies, but using A10 EXTEM of not more than 35 mm as the sole transfusion criterion can lead to unnecessary utilization of PLTs and fibrinogen‐rich products.