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Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation

Eva Montalvá1,2, Manuel Rodríguez-Perálvarez2,3, Annabel Blasi4

  • 1Department of HPB Surgery and Transplantation, La Fe University Hospital and University of Valencia, Instituto de Investigación Sanitaria de La Fe, Valencia, Spain.

Transplantation
|January 9, 2022
PubMed

Insights

Liver transplant (LT) patients increasingly use anticoagulation and antiplatelet therapies. This consensus provides expert guidance on their use, monitoring, and management for better clinical decision-making.

Area of Science:

  • Transplantation Medicine
  • Hematology
  • Pharmacology

Background:

  • Anticoagulation and antiplatelet therapies are frequently used in liver transplant (LT) candidates and recipients.
  • Cardiovascular comorbidities, portal vein thrombosis, and posttransplant complications necessitate these treatments.
  • Newer oral anticoagulants and antiplatelet agents present challenges due to limited evidence and monitoring requirements.

Purpose of the Study:

  • To establish consensus on the use of anticoagulation and antiplatelet therapies in liver transplantation.
  • To provide guidance on indications, drug selection, dosing, and timing from waitlisting to post-LT surveillance.
  • To address the clinical challenges posed by novel anticoagulant and antiplatelet agents in LT patients.

Main Methods:

  • A multidisciplinary expert group conducted a literature review.
  • 21 clinically relevant questions were formulated using the patient-intervention-comparison-outcome (PICO) format.
  • Recommendations were drafted and validated by a panel of 24 LT delegates using a modified Delphi approach.

Main Results:

  • The consensus statement offers key recommendations for anticoagulation and antiplatelet therapy in LT.
  • It addresses the use of these therapies from pre-transplant to post-transplant surveillance.
  • Guidance is provided for managing complications and monitoring drug activity.

Conclusions:

  • This consensus aims to improve and standardize clinical decision-making regarding anticoagulation and antiplatelet therapies in liver transplantation.
  • It provides a framework for managing complex therapeutic scenarios in LT patients.
  • The recommendations are based on expert consensus and literature review to address current clinical heterogeneity.

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