Eg. Pivalizza et al., THROMBOELASTOGRAPHY WITH HEPARINASE IN ORTHOTOPIC LIVER-TRANSPLANTATION, Journal of cardiothoracic and vascular anesthesia, 12(3), 1998, pp. 305-308
Citations number
13
Categorie Soggetti
Anesthesiology,"Peripheal Vascular Diseas","Cardiac & Cardiovascular System
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.