Anesth Pain Med.  2020 Apr;15(2):143-151. 10.17085/apm.2020.15.2.143.

Viscoelastic coagulation test for liver transplantation

• Park SY

• KMID: 2500964
• DOI: http://doi.org/10.17085/apm.2020.15.2.143

Abstract

Coagulation and transfusion management in patients undergoing liver transplantation is challenging. Proper perioperative monitoring of hemostasis is essential to predict the risk of bleeding during surgery, to detect potential causes of hemorrhage in time, and to guide hemostatic therapy. The value of conventional coagulation test is questionable in the acute perioperative setting due to their long turnaround time and the inability to adequately reflect the complex changes in hemostasis in patients with liver disease. Viscoelastic coagulation tests provide simultaneous measurement of multiple aspects of whole-blood coagulation including plasmatic coagulation and fibrinolytic factors and inhibitors that reflect most aspects of hemostasis. Coagulation initiation, mechanical clot stability, and fibrinolysis can be estimated immediately using point-of-care techniques. Therefore, viscoelastic coagulation tests including ROTEM & TEG would be useful to guide patient blood management strategy during liver transplantation.

Keyword

Blood coagulation disorders; Blood coagulation tests; Liver transplantation; Thromboelastography

Figure

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  Fig. 1. Viscoelastic coagulation test using whole blood. CT: clotting time, R: reaction time, CFT: clot formation time, MCF: maximum clot firmness, MA: maximum amplitude.

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  Fig. 2. Examples of thromboelastography during liver transplantation. (A) Preanhepatic phase. (B) Anhepatic phase. (C) Five minutes after reperfusion. (D) Neohepatic phase. R: reaction time, MA: maximum amplitude.

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