THROMBOELASTOGRAPHY WITH HEPARINASE IN ORTHOTOPIC LIVER-TRANSPLANTATION

Objective: To investigate the role of heparin in the postreperfusion c oagulopathy during liver transplantation with heparinase-guided thromb oelastography. Design: A prospective, interventional study. Setting: A university-affiliate hospital. Participants: Twenty-six patients unde rgoing orthotopic liver transplantation (OLT), Interventions: Blood dr awn at five intervals for thromboelastography assessment with native ( 12 patients) or celite blood (14 patients) compared with simultaneous thromboelastography traces with added heparinase, Main Results: In the native samples, the prolonged R (reaction) and K (coagulation) time a nd decreased alpha angle were corrected in heparinase thromboelastogra ph traces immediately before reperfusion and 10 minutes postreperfusio n, In the celite-accelerated samples, the heparinase traces showed cor rection of the R and K times and alpha angle only at the 10-minute pos treperfusion stage. In seven patients who had thromboelastography perf ormed after protamine administration, there were no differences betwee n celite and heparinase-celite traces. Conclusions: Heparinase-treated thromboelastography offered compelling evidence for the presence of h eparin-like activity after liver graft reperfusion. The objective evid ence provided by this modification of thromboelastography-guided prota mine administration and was useful in identifying one of the many pote ntial causes of postreperfusion bleeding in patients undergoing OLT. C opyright (C) 1998 by W.B. Saunders Company.