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A hypercoagulable state follows orthotopic liver transplantation
R L Stahl1, A Duncan, M A Hooks
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322.
Hepatology (Baltimore, Md.)
|September 1, 1990
Summary
Postoperative liver transplant patients exhibit a prothrombotic state due to coagulation imbalances, increasing hepatic artery thrombosis risk. A low-dose heparin and fresh frozen plasma regimen prevented thrombosis in 65 transplants.
Area of Science:
- Hepatology
- Transplantation Surgery
- Coagulation Science
Background:
- Hepatic artery thrombosis (HAT) is a severe postoperative complication after liver transplantation, often requiring retransplantation.
- Understanding the coagulation mechanism's role is crucial for preventing HAT.
Purpose of the Study:
- To assess the dynamic changes in procoagulant and anticoagulant proteins during the early postoperative period (10 days) after liver transplantation.
- To investigate the relationship between these coagulation factor levels and the risk of HAT.
Main Methods:
- Prospective study of 41 liver transplant recipients.
- Serial measurement of procoagulant and anticoagulant protein levels (including factors V, VII, VIII, antithrombin III, proteins C, and S) and thrombin/antithrombin complexes.
- Clinical monitoring for hepatic artery thrombosis.
Main Results:
- Procoagulant factors normalized by day 3, with supernormal Factor VIII levels observed.
- Anticoagulant proteins (antithrombin III, proteins C, and S) showed delayed recovery, with significant deficiencies noted.
- Elevated thrombin/antithrombin complexes indicated ongoing in vivo coagulation activation, suggesting a prothrombotic state.
Conclusions:
- Liver transplant recipients experience a transient prothrombotic state in the early postoperative period due to an imbalance favoring coagulation.
- This hemostatic imbalance may significantly contribute to the high risk of hepatic artery thrombosis.
- A prophylactic regimen of low-dose heparin and fresh frozen plasma has demonstrated success in preventing HAT in a consecutive series of liver transplants.