Fatal Pulmonary Embolism During Liver Transplantation in a Patient With Fulminant Hepatic Failure: A Diagnostic Challenge of the “Flat-Line” Thromboelastogram

El-Baghdadi, Mariam M.; Sakai, Tetsuro

doi:10.1053/j.jvca.2009.07.013

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…Flat-line nTEG does not indicate severe deficiency of coagulation factors in most cases. El-Baghdadi et al [11] reported that rapid transfusion of coagulation factors and platelets in flat-line TEG patients resulted in intracardiac thrombosis and pulmonary thromboembolism. The use of anti-fibrinolytics for hyperfibrinolysis and protamine for heparin effect may be an effective treatment modality in these patients, but there is also concern about potential adverse events [12,13].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of “Flat-Line” Thromboelastography After Reperfusion During Liver Transplantation

Kim

Song

Kim

et al. 2015

Transplantation Proceedings

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Section: Discussionmentioning

confidence: 99%

Evaluation of “Flat-Line” Thromboelastography After Reperfusion During Liver Transplantation

Kim

Song

Kim

et al. 2015

Transplantation Proceedings

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“…Clot lysis was determined to be positive when lysis at 30 minutes was more than an 8% reduction of the amplitude after TEG achieved the maximum amplitude . A flat line in TEG was defined as the alpha angle and the maximum amplitude both remaining zero for more than 30 minutes . The use of antifibrinolytic agents before ICA was also recorded.…”

Section: Methodsmentioning

confidence: 99%

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

et al. 2013

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Liver transplantation (LT) is one of the highest risk noncardiac surgeries. We reviewed the incidence, etiologies, and outcomes of intraoperative cardiac arrest (ICA) during LT. Adult cadaveric LT recipients from January 1, 2001 through December 31, 2009 were reviewed. ICA was defined as an event requiring either closed chest compression or open cardiac massage. Cardiac arrest patients who recovered with only pharmacological interventions were excluded. Data included etiologies and outcomes of ICA, intraoperative deaths (IDs) and hospital deaths (HDs), and potential ICA risk factors. ICA occurred in 68 of 1238 LT recipients (5.5%). It occurred most frequently during the neohepatic phase (60 cases or 90%), and 39 of these cases (65.0%) experienced ICA within 5 minutes after graft reperfusion. The causes of ICA included postreperfusion syndrome (PRS; 26 cases or 38.2%) and pulmonary thromboembolism (PTE; 24 cases or 35.3%). A higher Model for End-Stage Liver Disease (MELD) score was found to be the most significant risk factor for ICA. The ID rate after ICA was 29.4% (20 cases), and the HD rate was 50.0% (34 cases). The 30-day patient survival rate after ICA was 55.9%, and the 1-year survival rate was 45.6%: these rates were significantly lower (P < 0.001) than those for non-ICA patients (97.4% and 85.1%, respectively). In conclusion, the incidence of ICA in adult cadaveric LT was 5.5% with an intraoperative mortality rate of 29.4%. ICA most frequently occurred within 5 minutes after reperfusion and resulted mainly from PRS and PTE. A higher MELD score was identified as a risk factor.

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“…Sakai and colleagues 36 suggested the importance of flatline TEG as an associated finding of TEG in patients who developed this lethal condition. 35,36 In their case series of 495 LTs, they found the incidence of PTE was 4.0% (20 cases). Cardiac arrest preceded the diagnosis of PTE (75% [15]), and PTE occurred during the neohepatic phase (85% [17]), especially within 30 minutes after graft reperfusion (70% [14]).…”

Section: Postoperative Hepatic Artery Thrombosismentioning

confidence: 98%

Viscoelastic testing in liver transplantation

Sakai

2020

Transfusion

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Despite the lack of large randomized clinical studies, viscoelastic tests (VETs) have been a critical armamentarium for hemostatic control in liver transplantation (LT) since the 1960s. Many transplant institutions have adopted VETs in their clinical practice. Several small‐size randomized clinical trials on LT patients have suggested that VET‐guided hemostatic treatment algorithms have led to decreased indications for and amounts of transfused blood products, especially fresh‐frozen plasma, compared to standard laboratory‐based hemostatic management. VETs have also been reported to offer insight into the diagnosis and prediction of LT patients' development of hypercoagulability‐related morbidity and mortality. There is still a need for VET device–specific hemostatic algorithms in LT, and clinicians must take into account the tendency to underestimate the coagulation capacity of VETs in patients with end‐stage liver disease where hemostasis is rebalanced.

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Fatal Pulmonary Embolism During Liver Transplantation in a Patient With Fulminant Hepatic Failure: A Diagnostic Challenge of the “Flat-Line” Thromboelastogram

Cited by 17 publications

References 14 publications

Evaluation of “Flat-Line” Thromboelastography After Reperfusion During Liver Transplantation

Evaluation of “Flat-Line” Thromboelastography After Reperfusion During Liver Transplantation

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

Viscoelastic testing in liver transplantation

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