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Related Experiment Video

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In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

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[Use of viscoelastic methods in surgery].

D Šmíd, J Zatloukal, T Kural

Rozhledy V Chirurgii : Mesicnik Ceskoslovenske Chirurgicke Spolecnosti

|May 25, 2018

Summary

Standard coagulation tests may overestimate coagulopathy after major liver surgery. Viscoelastic methods like ROTEM show no actual clotting disorder, preventing unnecessary blood product transfusions and associated risks.

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Area of Science:

Anesthesiology and Perioperative Medicine
Hepatobiliary Surgery
Hematology

Background:

Major liver resections carry significant risks, including high morbidity and mortality often linked to blood loss.
Postoperative coagulopathy, diagnosed via standard tests, frequently leads to blood derivative transfusions.
Recent evidence questions traditional coagulopathy diagnosis, suggesting viscoelastic methods offer a more accurate assessment.

Purpose of the Study:

To compare standard coagulation tests with viscoelastic methods (ROTEM) in patients undergoing major liver resection.
To determine if coagulopathy diagnosed by standard tests is confirmed by viscoelastic assessment.
To evaluate the clinical implications of these diagnostic discrepancies for patient management.

Main Methods:

Prospective observational study conducted in a Surgical Intensive Care Unit over one year.
Inclusion of 18 patients who underwent major liver resection.
Comparison of standard coagulation test results with rotational tromboelastometry (ROTEM) findings when coagulopathy was suspected.

Main Results:

Standard coagulation tests indicated coagulopathy in 15 out of 18 patients (83%).
Subsequent ROTEM examinations in these patients revealed no evidence of a coagulation disorder.
A significant discordance was observed between standard laboratory tests and viscoelastic assessment.

Conclusions:

Viscoelastic methods (ROTEM) demonstrate no coagulopathy in patients after major hepatic surgery, contrary to standard tests.
Accurate assessment using viscoelastic methods can prevent unnecessary blood product transfusions and their associated risks.
Viscoelastic methods provide crucial insights into coagulation, supporting their role in postoperative management after liver resections.