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Thromboelastography with heparinase in orthotopic liver transplantation
E G Pivalizza1, D C Abramson, F S King
1Department of Anesthesiology, University of Texas Health Science Center, Houston 77030, USA.
Objective:
To investigate the role of heparin in the postreperfusion coagulopathy during liver transplantation with heparinase-guided thromboelastography.
Design:
A prospective, interventional study.
Setting:
A university-affiliated hospital.
Participants:
Twenty-six patients undergoing orthotopic liver transplantation (OLT).
Interventions:
Blood drawn at five intervals for thromboelastography assessment with native (12 patients) or celite blood (14 patients) compared with simultaneous thromboelastography traces with added heparinase.
Main Results:
In the native samples, the prolonged R (reaction) and K (coagulation) time and decreased alpha angle were corrected in heparinase thromboelastograph traces immediately before reperfusion and 10 minutes postreperfusion. In the celite-accelerated samples, the heparinase traces showed correction of the R and K times and alpha angle only at the 10-minute postreperfusion stage. In seven patients who had thromboelastography performed after protamine administration, there were no differences between celite and heparinase-celite traces.
Conclusions:
Heparinase-treated thromboelastography offered compelling evidence for the presence of heparin-like activity after liver graft reperfusion. The objective evidence provided by this modification of thromboelastography-guided protamine administration and was useful in identifying one of the many potential causes of postreperfusion bleeding in patients undergoing OLT.