Critical Importance of Low-Dose Tissue Plasminogen Activator Policy for Treating Intraoperative Pulmonary Thromboembolism During Liver Transplantation

Seminars in Cardiothoracic and Vascular Anesthesia
Daniel MandellTetsuro Sakai

Abstract

Tissue plasminogen activator (tPA) has been reported to treat intraoperative pulmonary thromboembolism (PTE) during liver transplantation (LT). However, tPA administration is often delayed due to fear of uncontrolled bleeding and storage in a refrigerator outside of operating rooms. Various dosages of tPA were used. We hypothesize that a policy of tPA storage and low dosage use improves patient outcomes. At a transplantation center, a multidisciplinary committee has implemented a tPA policy since April 2014, which includes the following: (1) timely administering of low-dose tPA (0.5-4 mg) for intraoperative PTE; (2) keeping 2 vials of tPA (2 mg/vial) in the operating room at room temperature; and (3) transferring unused tPA vials to the cardiology catheterization laboratory for next-day use. A prospective observational study was conducted to record the incidence and outcome of PTE during LTs. Over the next 19 months, 99 adult deceased donor LTs were performed with 1 (1.0%) intraoperative PTE. A 45-year-old woman with hepatitis C developed PTE within 5 minutes after graft reperfusion. A 2-mg tPA was immediately administered via a central venous line with hemodynamic improvement and clot lysis. Thromboelastography was normalized ...Continue Reading

References

Sep 12, 2001·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·E GologorskyY Kang
Nov 13, 2002·Journal of the American College of Cardiology·Gabriel ThabutMichel Fournier
Jul 24, 2004·Anesthesia and Analgesia·Raymond M PlaninsicAmadeo Marcos
Jun 27, 2006·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ton LismanFrank W G Leebeek
Dec 23, 2006·Radiology·Paul D SteinUNKNOWN PIOPED II Investigators

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Citations

Feb 16, 2019·Seminars in Cardiothoracic and Vascular Anesthesia·J Mauricio Del RioMiklos D Kertai
May 9, 2019·Seminars in Cardiothoracic and Vascular Anesthesia·Natalie K SmithTetsuro Sakai

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