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Coagulopathy management in liver transplantation
1Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, Health Universitat de Barcelona Campus, Barcelona, Spain. asabatep@bellvitgehospital.cat
Transplantation Proceedings
|July 31, 2012
Summary
Liver transplant bleeding risk factors include patient age and liver disease severity. Antifibrinolytic therapy can reduce red blood cell needs, guided by clot firmness or low fibrinogen levels.
Area of Science:
- Hepatology
- Transplantation Surgery
- Hematology
Background:
- Liver transplantation involves significant bleeding risks due to coagulopathy.
- Coagulopathy worsens during hepatectomy and anhepatic phases, exacerbated by portal hypertension.
- Graft reperfusion can further impair coagulation, necessitating careful management.
Purpose of the Study:
- To review the factors influencing bleeding and transfusion during liver transplantation.
- To discuss the management of coagulopathy and fibrinolysis in this context.
- To highlight the role of antifibrinolytic therapy and platelet support.
Main Methods:
- Literature review of factors affecting bleeding and transfusion in liver transplantation.
- Analysis of coagulopathy mechanisms during different surgical phases.
- Evaluation of therapeutic strategies for managing bleeding complications.
Main Results:
- Bleeding risk is linked to age, liver disease severity, hemoglobin, and fibrinogen.
- Administration of fluids and blood products can paradoxically worsen coagulopathy.
- Antifibrinolytic drugs show potential in reducing red blood cell requirements.
Conclusions:
- Hypofibrinogenemia requires correction in high-bleeding-risk situations.
- Antifibrinolytic therapy is guided by thromboelastometry or fibrinogen levels (<1 g/L).
- Platelet transfusion is crucial for severe thrombocytopenia with active bleeding.
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