Thromboprophylaxis With Heparin During Orthotopic Liver Transplantation: Comparison of Hepcon HMS Plus and Anti-Xa Assays for Low-Range Heparin

Nicolau‐Raducu, Ramona; Occhipinti, Elise; Marshall, Thomas; Koveleskie, Joseph; Ganier, Donald; Evans, Brian; Daly, William J.; Fish, Brian L.; Cohen, Ari J.; Reichman, Trevor; Bruce, David S.; Bohórquez, Humberto; Seal, John; Ahmed, Emily; Carmody, Ian C.; Loss, George E.; Rayburn, Jonathan; Nossaman, Bobby D.

doi:10.1053/j.jvca.2016.08.001

Cited by 10 publications

(8 citation statements)

References 31 publications

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“…Mechanical compression stockings were used intraoperatively in all recipients. In July 2017, routine intraoperative thromboprophylaxis with intravenous heparin (30 units/kg) was instituted at the time of portal clamping in all recipients. Once the postoperative platelet count was >40 × 10 9 /L, 5000 units of subcutaneous heparin every 12 hours plus 81 mg of aspirin per os were initiated.…”

Section: Methodsmentioning

confidence: 99%

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

et al. 2019

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Detrimental consequences of hypofibrinolysis, also known as fibrinolysis shutdown (FS), have recently arisen, and its significance in liver transplantation (LT) remains unknown. To fill this gap, this retrospective study included 166 adults who received transplants between 2016 and 2018 for whom baseline thromboelastography was available. On the basis of percent of clot lysis 30 minutes after maximal amplitude, patients were stratified into 3 fibrinolysis phenotypes: FS, physiologic fibrinolysis, and hyperfibrinolysis. FS occurred in 71.7% of recipients, followed by physiologic fibrinolysis in 19.9% and hyperfibrinolysis in 8.4%. Intraoperative and postoperative venous thrombosis events occurred exclusively in recipients with the FS phenotype. Intraoperative thrombosis occurred with an overall incidence of 4.8% and was associated with 25.0% in-hospital mortality. Incidence of postoperative venous thrombosis within the first month was deep venous thrombosis/pulmonary embolism (PE; 4.8%) and portal vein thrombosis/ hepatic vein thrombosis (1.8%). Massive transfusion of ≥20 units packed red blood cells was required in 11.8% of recipients with FS compared with none in the other 2 phenotype groups (P = 0.01). Multivariate analysis identified 2 pretransplant risk factors for FS: platelet count and nonalcoholic steatohepatitis/cryptogenic cirrhosis. Recursive partitioning identified a critical platelet cutoff value of 50 × 10 9 /L to be associated with FS phenotype. The hyperfibrinolysis phenotype was associated with the lowest 1-year survival (85.7%), followed by FS (95.0%) and physiologic fibrinolysis (97.0%). Infection/multisystem organ failure was the predominant cause of death; in the FS group, 1 patient died of exsanguination, and 1 patient died of massive intraoperative PE. In conclusion, there is a strong association between FS and thrombohemorrhagic complications and poorer outcomes after LT. Liver Transplantation 25 380-387 2019 AASLD.

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Section: Methodsmentioning

confidence: 99%

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

et al. 2019

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“…In a recent study, the concentration of heparin in post-reperfusion circulating blood after the liver transplantation obtained using HMS plus was compared against the laboratory standard anti-Xa assay. The results were significantly positive, inferring that the laboratory anti-Xa assay-dependent heparin measurement could be replaced with the HMS plus system [147]. iSTAT (Abbott Laboratories, Chicago, III, USA) is one of the most successful multi-test analysers, offering a range of blood chemistry tests, cardiac markers and coagulation tests, including PT/INR and ACT [148].…”

Section: Commercially Available Devicesmentioning

confidence: 99%

Microfluidics in Haemostasis: A Review

et al. 2020

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Haemostatic disorders are both complex and costly in relation to both their treatment and subsequent management. As leading causes of mortality worldwide, there is an ever-increasing drive to improve the diagnosis and prevention of haemostatic disorders. The field of microfluidic and Lab on a Chip (LOC) technologies is rapidly advancing and the important role of miniaturised diagnostics is becoming more evident in the healthcare system, with particular importance in near patient testing (NPT) and point of care (POC) settings. Microfluidic technologies present innovative solutions to diagnostic and clinical challenges which have the knock-on effect of improving health care and quality of life. In this review, both advanced microfluidic devices (R&D) and commercially available devices for the diagnosis and monitoring of haemostasis-related disorders and antithrombotic therapies, respectively, are discussed. Innovative design specifications, fabrication techniques, and modes of detection in addition to the materials used in developing micro-channels are reviewed in the context of application to the field of haemostasis.

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“…Several ACT devices are commercially available, which utilize Celite, glass beads, or kaolin-based activators, and detect clot initiation via mechanical, optical, or amperometric approaches to deduce clotting time. 8,9 Recent advances in heparin management systems have improved anticoagulation management by facilitating heparin and protamine titration based on individual patient requirements. 8 Whole blood tests that measure the international normalized ratio (INR, as derived from the PT) have been utilized for monitoring warfarin anticoagulation in home-or out-patient settings, and have been shown to improve adherence to therapy and patient outcomes.…”

Section: Approaches For Point-of-care Coagulation Testingmentioning

confidence: 99%

“…8,9 Recent advances in heparin management systems have improved anticoagulation management by facilitating heparin and protamine titration based on individual patient requirements. 8 Whole blood tests that measure the international normalized ratio (INR, as derived from the PT) have been utilized for monitoring warfarin anticoagulation in home-or out-patient settings, and have been shown to improve adherence to therapy and patient outcomes. [10][11][12] Other approaches currently in development include the use of quartz crystal, [13][14][15] magnetoelastic transducers, 16,17 microelectromechanical systems-based devices, 18 and surface plasmon resonance techniques 19,20 to infer the PT.…”

Section: Approaches For Point-of-care Coagulation Testingmentioning

confidence: 99%

Comprehensive Coagulation Profiling at the Point-of-Care Using a Novel Laser-Based Approach

Nadkarni

2019

Semin Thromb Hemost

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Delays in identifying internal bleeding are life-threatening, thus underscoring the need for rapid and comprehensive coagulation profiling at the bedside. The authors review a novel optical coagulation profiler that measures several coagulation metrics including prothrombin time, activated clotting time, clot polymerization rate (α-angle), clot stiffness (maximum amplitude), fibrinolysis (LY), and platelet function, using a single multifunctional instrument. The optical profiler is based on the principles of Laser Speckle Rheology that quantifies tissue viscoelasticity from light scattering patterns called laser speckle. To operate the optical profiler, whole blood (40 μL) is loaded into a disposable cartridge, laser speckle patterns are recorded via a camera, and the viscoelasticity of clotting blood is estimated from speckle intensity fluctuations. By monitoring alterations in viscoelastic moduli over time during clot initiation, thrombin generation, fibrin crosslinking, clot stabilization, and LY, global coagulation parameters are obtained within 10 minutes using a drop of whole blood. Clinical testing in over 500 patients to date has confirmed the accuracy of the optical profiler for comprehensively assessing coagulation status against conventional coagulation tests and thromboelastography. Recent studies have further demonstrated the capability to quantify platelet aggregation induced by adenosine diphosphate in a drop of platelet-rich-plasma in the absence of applied shear stress. Together, these studies demonstrate that global coagulation profiling in addition to platelet function may be accomplished using a single multifunctional device. Thus, by enabling rapid and comprehensive coagulation and platelet function profiling at the bedside, the optical profiler will likely advance the capability to identify and manage patients with an elevated risk for hemorrhage.

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Thromboprophylaxis With Heparin During Orthotopic Liver Transplantation: Comparison of Hepcon HMS Plus and Anti-Xa Assays for Low-Range Heparin

Cited by 10 publications

References 31 publications

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

Microfluidics in Haemostasis: A Review

Comprehensive Coagulation Profiling at the Point-of-Care Using a Novel Laser-Based Approach

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