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Updated: May 14, 2025

Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo

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Hyperfibrinolysis Detection During Liver Transplantation Using Viscoelastometry.

Sarah Thaler¹, Anna Zorn¹, Isabell Aster¹

¹Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany.

Clinical Transplantation

|May 11, 2025

Summary

This summary is machine-generated.

The ecarin-based test (ECA-test) is more sensitive than the tissue factor-based test (EX-test) for detecting hyperfibrinolysis during liver transplantation, identifying it more frequently and earlier.

Keywords:

ECA‐test coagulation hyperfibrinolysis liver transplantation viscoelastometry

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Area of Science:

Coagulation and Hemostasis
Transplantation Medicine
Clinical Diagnostics

Background:

End-stage liver disease disrupts hemostasis, termed rebalanced hemostasis.
Liver transplantation further destabilizes hemostatic balance.
Hyperfibrinolysis is a significant complication during liver transplantation.

Purpose of the Study:

To assess the incidence of hyperfibrinolysis during liver transplantation.
To compare the efficacy of an ecarin-based test (ECA-test) versus a tissue factor-based test (EX-test) in monitoring hyperfibrinolysis.

Main Methods:

Prospective, observational study involving 30 liver transplantations.
Viscoelastic monitoring using ClotPro assays (EX-test, FIB-test, AP-test, ECA-test) at five time points.
Hyperfibrinolysis defined as maximum lysis ≥15%; Lysis Detection Time (LDT) measured for lysis velocity.

Main Results:

The ECA-test detected hyperfibrinolysis more frequently (21% vs. 15%, p=0.039) and in more patients than the EX-test.
Hyperfibrinolysis was detected significantly earlier with the ECA-test (median LDT 2100s vs. 3300s, p<0.001).

Conclusions:

The ecarin-based test demonstrates superior sensitivity for monitoring hyperfibrinolysis during liver transplantation.
The ECA-test provides more frequent and earlier detection of hyperfibrinolysis compared to the tissue factor-based test.