Predictive factors of hyperfibrinolytic activity during liver transplantation in cirrhotic patients

Steib, A.; Gengenwin, N.; Freys, G.; Boudjéma, Karim; Levy, Sara; Otteni, J.C.

doi:10.1093/bja/73.5.645

Cited by 68 publications

(54 citation statements)

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“…In such patients, the incidence of hyperfibrinolysis varies from 19% to 95% [6][7][8] and may contribute to serious bleeding complications. The pathogenesis of hyperfibrinolysis in liver cirrhosis is not yet clearly known.…”

Section: Discussionmentioning

confidence: 99%

High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis

Spadaro¹,

Tortorella²,

Morace³

et al. 2008

WJG

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Section: Discussionmentioning

confidence: 99%

High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis

Spadaro¹,

Tortorella²,

Morace³

et al. 2008

WJG

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“…Most of these studies have failed to define, preoperatively, biological factors (specially those related to hemostatic disorders) predictive of hemorrhage. 1,[7][8][9][10] Surgical conditions such as experience of the team, use of specific coagulation devices and previous abdominal surgery have, more often, been blamed. 1,2 Moreover, the majority of these trials included various types of liver disease in the patient population under study, mixing acute and chronic cases.…”

Section: Méthode : Quatre Cent DIX Patients Successifs Ont Participé mentioning

confidence: 99%

“…For all these reasons, several attempts have been made to identify patients with a high risk of bleeding and to define preoperative factors which could influence intraoperative bleeding. 5,[7][8][9][10] Results have been contradictory, mainly because of non-homogenous patient selection, surgical conditions and intraoperative management. Our study focussed on chronic liver diseases and preoperative clotting data.…”

Section: Se (%) Sp (%) Ppv (%) Npv (%)mentioning

confidence: 99%

“…This latter factor was also identified as a predictive variable in a previous small study of cirrhotic patients who experienced severe intraoperative hyperfibrinolysis. 7 Its preoperative increase may reflect an imbalance between factors promoting fibrinolysis or a low grade of disseminated intravascular coagulation. The predictive role of Hb found in our study was not surprising.…”

Section: Se (%) Sp (%) Ppv (%) Npv (%)mentioning

confidence: 99%

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Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict

Steib

Freys

Lehmann

et al. 2001

Can J Anesth/J Can Anesth

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147

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Purpose: To identify preoperative factors associated with high blood losses during liver transplantation for chronic end-stage liver disease.Methods: Four hundred and ten consecutive patients were included in this retrospective study. Blood losses were calculated, based on transfusion requirements. The population was divided into two groups: the upper quartile was defined as the high blood loss (HBL) group and the lower three quartiles as the low blood loss group. Fourteen preoperative variables were collected. Qualitative variables consisted of the type of hepatopathy, Child-Pugh's classification, sex, the surgical team's experience, previous abdominal surgery and portal hypertension. Quantitative variables were age, hemoglobin concentration Hb, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen concentration, fibrin degradation products (FDP) and euglobulin lysis time. Univariate analysis and stepwise multivariate analysis were conducted.Results: Patients in the HBL group required 12 units of red blood cell or more to maintain a Hb $100g·L -1 . HBL was associated with severe liver disease, previous abdominal surgery, use of a venovenous bypass and little surgical experience in orthotopic liver transplantation (OLT). In the HBL group several hemostatic parameters were more disturbed before surgery. The multivariate analysis disclosed three independent variables associated with HBL: Hb and FDP concentrations and previous upper abdominal surgery. When combined, these resulted in a high specificity (98%) but low sensitivity to predict blood loss.Conclusion: Despite our efforts we were unable to identify predictive risk factors of bleeding during OLT even in a homogeneous population. Centres should evaluate their practice individually in an attempt to identify patients at high risk of being transfused.

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“…Protease inhibitors, such as aprotinin, ⑀-aminocaproic acid, and tranexamic acid, reduce hyperfibrinolysis and platelet dysfunction and have been found to reduce blood transfusion requirements in cardiac surgery with cardiopulmonary bypass 11 and liver surgery. [12][13][14][15][16][17] This effect on blood transfusion requirements can be achieved with no side effects in most patients. 18 Other factors such as the experience of the surgeon, improvements in surgical and anesthesiological techniques, venovenous bypass, and donor graft cold ischemia time are more likely to be important factors in intraoperative and/or postoperative blood loss than in intraoperative coagulation monitoring.…”

confidence: 97%

Coagulation Techniques Are Not Important In Directing Blood Product Transfusion During Liver Transplantation

Reyle-Hahn

1997

Liver Transplantation

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Preoperative acquired clotting parameters such as prothrombin time, activated partial thromboplastin time, antithrombin III, platelet concentration, and fibrinogen show coagulopathy caused by insufficiency of the diseased liver. Intraoperative determination of clotting factors or parameters is not helpful to direct intraoperative transfusion of blood, blood components, or platelets because transfusions performed solely for correction of clotting data do not correlate with the real intraoperative requirements and increase the costs of orthotopic liver transplantation. However, the use of antihyperfibrinolytic drugs seems to reduce intraoperative blood loss. Patients with cirrhotic disorders caused by portalvenous hypertension show extensive collaterals and increased intravascular blood volume. Thus it is plausible that especially overcorrection of blood loss during the surgical preparation in the preanhepatic phase of the operation results in extensive blood loss. Therefore, to avoid blood loss we attempt to keep volume substitution to a minimum during the preanhepatic phase of the operation. In contrast, during the anhepatic and postanhepatic phases we attempt to reestablish normovolemia by transfusing red packed blood cells and fresh-frozen plasma. Strictly confined use of blood products in the preanhepatic phase, followed by later correction of intravascular blood volume, may reduce intraoperative blood loss; it also seems to ensure adequate substitution of clotting factors.

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Predictive factors of hyperfibrinolytic activity during liver transplantation in cirrhotic patients

Cited by 68 publications

References 0 publications

High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis

High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis

Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict

Coagulation Techniques Are Not Important In Directing Blood Product Transfusion During Liver Transplantation

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