Intraoperative evolution of coagulation parameters and t-PA/PAI balance in orthotopic liver transplantation

Thrombosis Research
D ArnouxJ Sampol

Abstract

The changes in coagulation and fibrinolysis were investigated in 10 patients undergoing orthotopic liver transplantation (OLT) which is known to be frequently associated with perturbations of haemostasis. The coagulation profile, already deteriorated before surgery in most patients, showed no appreciable further alteration. On the other hand, important modifications of fibrinolytic parameters occurred, essentially concerning tissue-type plasminogen activator (t-PA) and its specific inhibitor (PAI). t-PA activity constantly increased in the course of transplantation, reaching a maximum at the end of anhepaty. Large interindividual variations were noted in the level of t-PA activity (7.5 to 135 IU/ml). Free PAI activity followed a reverse kinetics, remaining low during the anhepatic stage, and dramatically increasing after allograft reperfusion. Despite the fibrinolytic potential related to high circulating t-PA levels, no biologic nor clinical evidence of systemic fibrinolysis was observed peroperatively. These findings suggest that PAI release could represent an early process making the use of antifibrinolytic drugs during OLT unnecessary.

References

Jan 1, 1979·Haemostasis·J J Emeis
Jan 1, 1969·Archives of Surgery·C G GrothT E Starzl
Jan 1, 1966·Archives of Surgery·K N Von KaullaT E Starzl

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Citations

Mar 1, 1992·Transplant International : Official Journal of the European Society for Organ Transplantation·J D BlankensteijnO T Terpstra
Jul 18, 1992·Lancet·J GrohM A Kratzer
Feb 1, 1997·Journal of Vascular Surgery·K A IlligC W Francis
Jul 30, 2004·Anesthesia and Analgesia·Vance G NielsenDale A Parks
Aug 11, 2017·Anesthesia and Analgesia·Katherine T ForkinJulie L Huffmyer
Jun 19, 2004·International Anesthesiology Clinics·Yves Ozier, Aline Albi
Aug 1, 1992·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·C M BakkerO T Terpstra
May 15, 2001·European Journal of Anaesthesiology·Y OzierP De Moerloose

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