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Strategies to avoid empiric blood product administration in liver transplant surgery.

Authors
  • Ahmad, Mian1
  • Mathew, Johann1
  • Iqbal, Usama1
  • Tariq, Rayhan1
  • 1 Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA.
Type
Published Article
Journal
Saudi Journal of Anaesthesia
Publisher
Medknow Publications
Publication Date
Jan 01, 2018
Volume
12
Issue
3
Pages
450–456
Identifiers
DOI: 10.4103/sja.SJA_712_17
PMID: 30100846
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Massive blood loss has been a dreaded complication of liver transplantation, and the accompanying transfusion is associated with adverse outcomes in the form of decreased patient and graft survival. With advances in both surgical techniques and anesthetic management during transplantation, blood and blood products requirements reduced significantly. However, transfusion practices vary among different centers. The altered coagulation parameters in patients with liver cirrhosis results in a state of "rebalanced hemostasis" and patients are just as likely to clot as they are to bleed. Commonly used coagulation tests do not always reflect this new state and can, therefore, be misleading. Transfusion of blood products solely to correct abnormal parameters may worsen the coagulation status, thus adversely affecting patient outcome. Point-of-care tests such as thromboelastometry more reliably predict the risk of bleeding in these patients and in addition may provide quicker turnaround times compared to routine tests. Perioperative management should also include the possibility of thrombosis in these patients, and the use of low-molecular-weight heparin correlates with better patient survival. This review article aims to highlight the concept of rebalanced hemostasis, limitation of routine coagulation tests, and harmful effect of empiric transfusion of blood products.

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