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Updated: May 11, 2026
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Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Intraoperative hypercoagulability during liver transplantation as demonstrated by thromboelastography
Dominik Krzanicki1, Anita Sugavanam, Susan Mallett
1Department of Anaesthesia, Royal Free Hospital, London, United Kingdom. dominik.krzanicki@nhs.net
Summary
Hypercoagulation, indicated by high clot strength (G) and short reaction times (R) on thromboelastography (TEG), is common in liver transplant recipients. Its impact on thrombotic complications remains unclear, as conventional tests miss this hypercoagulable state.
Area of Science:
- Hepatology
- Transplant Surgery
- Hematology
Background:
- Liver disease paradoxically involves both bleeding and clotting risks.
- Conventional coagulation tests often fail to detect hypercoagulation in liver disease.
- The incidence of hypercoagulation in liver transplant recipients is not well understood.
Purpose of the Study:
- To assess the prevalence of hypercoagulation in liver transplant recipients using intraoperative thromboelastography (TEG).
- To investigate the association between TEG-defined hypercoagulation (short R times, high G values) and thrombotic complications.
- To evaluate the correlation between TEG parameters and conventional coagulation tests like INR.
Main Methods:
- Retrospective review of intraoperative TEG data from 124 liver transplant recipients.
- Analysis of TEG reaction times (R) and net clot strength (G) values.
- Correlation of TEG findings with patient diagnoses and thrombotic events.
Main Results:
- A significant prevalence of hypercoagulation was observed: 15.53% had high G values and 6.80% had short R times.
- Elevated hypercoagulation rates were noted in specific conditions like primary biliary cirrhosis (42.9%), primary sclerosing cholangitis (85.7%), fulminant hepatic failure (50%), and nonalcoholic steatohepatitis (37.5%).
- A poor correlation existed between TEG R time and INR, with 37.7% showing short R times despite INR > 2.
Conclusions:
- Intraoperative TEG frequently detects hypercoagulation (high G, short R) in liver transplant patients.
- Conventional coagulation tests are inadequate for identifying this hypercoagulable state.
- The clinical significance of TEG-detected hypercoagulation on thrombotic complications requires further investigation; unrecognized hypercoagulability may pose risks.
