Coagulation Management During Liver Transplantation: Use of Fibrinogen Concentrate, Recombinant Activated Factor VII, Prothrombin Complex Concentrate, and Antifibrinolytics
Document Type
Journal Article
Publication Date
6-1-2018
Journal
Seminars in Cardiothoracic and Vascular Anesthesia
Volume
22
Issue
2
DOI
10.1177/1089253217739689
Keywords
coagulopathy; fibrinogen concentrate; liver transplant; plasma transfusion; prothrombin complex concentrate
Abstract
© 2017, © The Author(s) 2017. Coagulation management, and transfusion practice in liver transplantation (LT) have been evolving in the recent years due to better understanding of coagulation abnormalities in end-stage liver disease, and clinical management of LT patients. Avoidance of allogeneic blood components is feasible in some patients, but multi-modal coagulation therapies may be necessary in others who develop complex coagulopathy due to hemorrhage, hemodilution, hypothermia, and acid-base disturbances. Transfusions of plasma and cryoprecipitate remain to be the mainstay therapy for procoagulant factor replacement during LT. Clinical efficacy and safety of these products are limited by logistic issues (eg, thawing), and mostly noninfectious complications. Considering potential alternatives to conventional transfusion is thus important to improve hemostatic resuscitation in complex LT cases. The present review is mainly focused on procoagulant properties of plasma and platelet transfusion, and currently available plasma-derived and recombinant factor concentrates, and antifibrinolytic agents in LT patients. The role of viscoelastic coagulation tests to guide specific component therapies will be also discussed.
APA Citation
Chow, J., Lee, K., Abuelkasem, E., Udekwu, O., & Tanaka, K. (2018). Coagulation Management During Liver Transplantation: Use of Fibrinogen Concentrate, Recombinant Activated Factor VII, Prothrombin Complex Concentrate, and Antifibrinolytics. Seminars in Cardiothoracic and Vascular Anesthesia, 22 (2). http://dx.doi.org/10.1177/1089253217739689