Monitoring of haemostasis in liver transplantation: comparison of laboratory based and point of care tests

Abstract

SummaryDuring orthotopic liver transplanatation haemostasis is often disturbed and coagulation monitoring is mandatory. We compared the results obtained by whole blood prothrombin time and activated partial thromboplastin time assays (Hemochron Ò ) and thrombelastometry (ROTEM Ò 05) with laboratory coagulation assays (prothrombin time, activated partial prothrombin time, fibrinogen, and platelet count) in samples obtained during orthotopic liver transplantations. Determination of prothrombin time and activated partial prothrombin time using the Hemochron device showed good correlation with laboratory coagulation assays (r = 0.912, p < 0.001, and r = 0.794, p < 0.001). Maximum clot firmness as determined by thrombelastometry correlated well with platelet count (r = 0.779, p < 0.001) and, to a lesser degree, with fibrinogen concentration (r = 0.590, p < 0.001). During orthotopic liver transplantation, prothrombin time and activated partial prothrombin time can be reliably determined by the Hemochron device, while thrombelastometry allows assessment of platelet count and fibrinogen concentration. Coagulation abnormalities during orthotopic liver transplanation are characterised by decreased coagulation factors, antifibrinolytic factors and endogeneous anticoagulant factors [1], all of which represent a major perioperative challenge as both bleeding episodes and thrombotic events can be precipitated [2,3]. Accordingly, monitoring of the coagulation system during liver transplantation is important.Besides standard laboratory methods, point of care assays are gaining increasing acceptance since their results are rapidly available [4][5][6][7][8]. However, only sparse information is available on the comparability of point of care coagulation assays with laboratory coagulation assays in this special setting.The purpose of this study was to compare the results obtained by two point of care assays (thrombelastometry and the Hemochron Ò device) with those of conventional laboratory assays during orthotopic liver transplantation. MethodsCoagulation values obtained during 20 consecutive orthotopic liver transplantations were analysed after approval by the Local Research Ethics Committee and written informed consent of the patients.

Rotational Thrombo Elastometry and Standard Coagulation Tests for Hepatic Patients undergoing Major Liver Resection

“…Clinically and during surgery many patients with high INR do not bleed even when no blood transfusion products are infused. Herbstreit et al demonstrated also that clot formation time of thrombelastometry and the standard coagulation tests as PT and aPTT showed poor correlation similar to our study [14]. The poor presence of blood cellular structures as endothelial cells and platelets during most of the standard conventional tests could explain the lack of a significant correlation between these tests and the ROTEM parameters due to the difference in methodology of measurement.…”

“…12Several studies with particular interest in hepatic patients subjected to liver surgery were able to present an activation of the coagulation cascade reaching some times to a hypercoagulable state due to the sustained up regulation of the coagulation process itself [13]. Standard coagulation tests in these situations could give false impression of a state of hypocoagulability when instead the patient would indeed need prophylactic anticoagulation measures to manage the undiagnosed hypercoagulable status [2][3][4]14].…”

Reliability of a point-of-care device for international normalized ratio testing during the three surgical phases of orthotopic liver transplantation: a retrospective observational study

“…Nevertheless, samples taken during the earlier phases of the transplantation support the findings of Herbstreit et al who found a strong positive correlation between pocINR and laboratory PT estimations (r = 0.91) using the same POC device in liver transplantation. 15 The pocINR performed well at predicting the direction of change of labINR between the three critical phases of liver transplantation (Fig. 3).…”

“…[15][16][17] As the trigger for intraoperative transfusion is usually at a lower INR level, this outcome is unlikely to be of relevance in a perioperative liver transplant population. Our study did not replicate this finding; however, relatively few (20%) INR readings in the labINR and pocINR groups were[2.5.…”

A Novel Blood Coagulation Measuring Method Based on the Viscoelasticity of Non-Newtonian Fluid

“…Advances in the blood coagulation test technology and the discovery of coagulation cascade have contributed to the rapid development of coagulation time testing. The main test methods include prothrombin time (PT), activated partial thromboplastin time (APTT), thromboplastin time (TT), and activation of coagulation time (ACT) [3] [4]. In order to obtain a comprehensive and effective evaluation of the blood coagulation and fibrinolysis function, it is far from enough to rely on routine tests and regular indicators, especially in a large surgical procedure such as a cardiac surgery and a liver transplant.…”