E G Pivalizza1, D C Abramson, F S King. 1. Department of Anesthesiology, University of Texas Health Science Center, Houston 77030, USA.
Abstract
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.
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.
Authors: Marco Ranucci; Ekaterina Baryshnikova; Giuseppe Isgrò; Concetta Carlucci; Mauro Cotza; Giovanni Carboni; Andrea Ballotta Journal: Crit Care Date: 2014-09-05 Impact factor: 9.097
Authors: Marco Senzolo; Seema Agarwal; Paola Zappoli; Sushang Vibhakorn; Susan Mallett; Andrew K Burroughs Journal: Liver Int Date: 2009-02-09 Impact factor: 5.828