Document Detail


Hemostasis and coagulation monitoring and management during liver transplantation.
MedLine Citation:
PMID:  19300254     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: The objective of this review is to evaluate the present state of nonpharmacological measures, pharmacological measures applied to reduce bleeding and perioperative blood products management during orthotopic liver transplantation. RECENT FINDINGS: Recent studies improve the knowledge in the hemostatic response in cirrhotic patients such as thrombin generation and platelet adhesion due to elevated levels of von Willebrand factor. Restrictive fluid therapy is an important measure to avoid hemodilution and so bleeding. Prophylaxis with antifibrinolytics is being questioned for the risk of thrombosis. Correction of coagulation defects with fresh frozen plasma has not reduced blood loss, and it has been related to worse outcome. Also, platelets administration has a negative effect in the outcome. SUMMARY: In order to maintain hemostatic system in compensated cirrhotic patient, every effort we do to improve it must consider not to imbalance it resulting in thrombi-hemorrhagic events. Pharmacological measures must be based on their clinical evidence. Identification of high risk bleeding patients would help in developing coagulation guidelines.
Authors:
Antònia Dalmau; Antoni Sabaté; Idoia Aparicio
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in organ transplantation     Volume:  14     ISSN:  1531-7013     ISO Abbreviation:  Curr Opin Organ Transplant     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-20     Completed Date:  2009-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9717388     Medline TA:  Curr Opin Organ Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  286-90     Citation Subset:  IM    
Affiliation:
Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelone, Barcelona, Spain. madalmau@bellvitgehospital.cat
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / adverse effects
Antifibrinolytic Agents / adverse effects
Blood Coagulation* / drug effects
Blood Coagulation Tests
Blood Loss, Surgical / prevention & control*
Drug Monitoring
Fibrinolytic Agents / adverse effects
Fluid Therapy / adverse effects
Hemorrhage / chemically induced,  prevention & control
Hemostasis* / drug effects
Humans
Liver Cirrhosis / blood,  surgery*
Liver Transplantation / adverse effects*
Platelet Transfusion / adverse effects
Practice Guidelines as Topic
Risk Assessment
Thrombosis / chemically induced,  prevention & control
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antifibrinolytic Agents; 0/Fibrinolytic Agents

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