Viscoelastic Monitoring to Guide Hemostatic Resuscitation in Liver Transplantation Surgery

Seminars in Cardiothoracic and Vascular Anesthesia
Kevin P Blaine, Tetsuro Sakai

Abstract

Coagulopathic bleeding must be anticipated during liver transplantation (LT) surgery. Patients with end-stage liver disease (ESLD) often present with disease-related hematologic disturbances, including the loss of hepatic procoagulant and anticoagulant clotting factors and thrombocytopenia. Transplantation surgery itself presents additional hemostatic changes, including hyperfibrinolysis. Viscoelastic monitoring (VEM) is often used to provide targeted, personalized hemostatic therapies for complex bleeding states including cardiac surgery and major trauma. The use in these coagulopathic conditions led to its application to LT, although the mechanisms of coagulopathy in these patients are quite different. While VEM is often used during transplant surgeries in Europe and North America, evidence supporting its use is limited to a few small clinical studies. The theoretical and clinical applications of the standard and specialized VEM assays are discussed in the setting of LT and ESLD.

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Citations

Apr 28, 2018·Seminars in Cardiothoracic and Vascular Anesthesia·Jeron ZerilloTetsuro Sakai
Jun 2, 2020·Expert Review of Clinical Pharmacology·Santiago R Leal-NovalManuel Múñoz-Gómez
Oct 23, 2020·Transfusion·Andrew C SayceChristine M Leeper

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Methods Mentioned

BETA
flow cytometry
Assay
blood drawn

Software Mentioned

RapidTEG
EXTEM
ROTEM
VEM
INTEM

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