| The use of thromboelastometry in the assessment of hemostasis during orthotopic liver transplantation reduces the demand for blood products. | |
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MedLine Citation:
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PMID: 20877262 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Bleeding due to fibrinolysis is a serious intraoperative complication during orthotopic liver transplantation (OLT). For a number of years aprotinin was used to minimize risk of this complication. This drug was however banned in 2007 and substituted with other antifibrinolytics. The aim of the study was to assess the potential of intraoperative thromboelastometry to evaluate hemostasis and channelize antifibrinolytic therapy. MATERIAL/METHODS: Since ban on aprotinin, 39 patients underwent OLT in our center with no monitoring of fibrinolysis (NMF). Severe disturbances of hemostasis assessed clinically only as a need for blood and blood products transfusion and were treated with transfusion of fresh frozen plasma only. In 2008 we started to use thromboelastometry (ROTEM group, n=39), which allowed for targeted treatment of hyperfibrinolysis with tranexamic acid. RESULTS: The need for blood transfusion in ROTEM group was insignificantly a lower than in NMF group (4.1±4.76 vs 5.53±4.89 units, p=0.2). Patients from ROTEM group required also less plasma transfusions (10.01±7.47 vs 13.15±6.62, p=0.06). Severe fibrinolysis was found in 3 patients from ROTEM group (7.7%) and was treated with tranexamic acid. CONCLUSIONS: Thromboelastometry provides an immediate diagnosis of fibrinolysis, justifies implementation of targeted treatment and confirms effectiveness of the therapy. In a larger study group it can also result in significant minimization of blood products transfusion during OLT. |
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Authors:
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Janusz Trzebicki; Edyta Flakiewicz; Maciej Kosieradzki; Beata Blaszczyk; Marcin Kołacz; Lidia Jureczko; Marek Pacholczyk; Andrzej Chmura; Beata Lagiewska; Wojciech Lisik; Dariusz Wasiak; Dariusz Kosson; Artur Kwiatkowski; Tomasz Lazowski |
Publication Detail:
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Type: Comparative Study; Evaluation Studies; Journal Article |
Journal Detail:
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Title: Annals of transplantation : quarterly of the Polish Transplantation Society Volume: 15 ISSN: 1425-9524 ISO Abbreviation: Ann. Transplant. Publication Date: 2010 Jul-Sep |
Date Detail:
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Created Date: 2010-09-29 Completed Date: 2011-03-30 Revised Date: 2012-05-09 |
Medline Journal Info:
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Nlm Unique ID: 9802544 Medline TA: Ann Transplant Country: Poland |
Other Details:
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Languages: eng Pagination: 19-24 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology and Intensive Care, The Medical University of Warsaw, Poland. jtrzebicki@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antifibrinolytic Agents / pharmacology, therapeutic use Aprotinin / pharmacology, therapeutic use Blood Coagulation / drug effects Blood Coagulation Tests / methods* Blood Transfusion / adverse effects Female Fibrinolysis / drug effects Hemorrhage / prevention & control Hemostasis* Humans Liver Transplantation / adverse effects* Male Middle Aged Platelet Transfusion / adverse effects Tranexamic Acid / pharmacology, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Antifibrinolytic Agents; 1197-18-8/Tranexamic Acid; 9087-70-1/Aprotinin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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