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Updated: Dec 6, 2025
Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Association between intraoperative rotational thromboelastometry or conventional coagulation tests and bleeding in
François M Carrier1, André Y Denault2, Anna Nozza3
1Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada; Critical Care Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.
Introduction:
Liver transplantation is associated with major blood loss and transfusions. Our objective was to evaluate the association between coagulation results (rotational thromboelastometry (ROTEM) and conventional coagulation tests) and intraoperative bleeding or perioperative red blood cell (RBC) transfusions in liver transplantation.
Methods:
We measured ROTEM values and conventional coagulation tests at the beginning of surgery, after graft reperfusion and at the end of surgery. We did bivariate correlation and multivariable regression analyses to explore the association between test results and either intraoperative bleeding or perioperative RBC transfusions.
Results:
We enrolled 75 consecutive patients. Median [Q1-Q3] intraoperative blood loss was 1400 mL [675-2300] and 59% of patients did not receive any RBC transfusion either intraoperatively or postoperatively. In multivariable analyses, FIBTEM maximal clot firmness (MCF) measured at the beginning of surgery was associated with lower intraoperative blood loss (ß = -106 mL for each mm; 95% CI, -203 to -9 mL). Both a higher haemoglobin concentration (multiplicative factor = 0.89 for each g/L; 95% CI, 0.84 to 0.95) and FIBTEM MCF measured at the end of surgery (multiplicative factor = 0.68 for each mm; 95% CI, 0.48 to 0.95) were associated with fewer postoperative RBC transfusions.
Conclusion:
FIBTEM MCF was strongly associated with intraoperative blood loss and postoperative transfusions while other coagulation results were not. This study might inform future clinical trials on ROTEM-based interventions in liver transplantation.
Study Registration:
Clinical Trials.gov: NCT02356068.
