%0 Journal Article
%A Leon-Justel, Antonio
%A Noval-Padillo,Jose A.
%A Alvarez-Rios, Ana I.
%A Mellado, Patricia
%A Gómez-Bravo, Miguel Ángel
%A Alamo, Jose M.
%A Porras, Manuel
%A Barrero, Lydia
%A Hinojosa, Rafael
%A Carmona, Magdalena
%A Vilches-Arenas, Angel
%A Guerrero, Juan M.
%T Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome
%D 2015
%U https://hdl.handle.net/10668/23208
%X BackgroundOptimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT).MethodsWe performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups.ResultsTransfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2–8] to 3 [0–5] (p < 0.001), plasma from 2 [0–4] to 0 (p < 0.001), and platelets from 1 [0–4] to 0 [0–1] (p < 0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13 ± 1.44 g (p = 0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p < 0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p = 0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p = 0.048, 17% vs. 2%, p < 0.001, and 29% vs. 16%, p = 0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications.ConclusionsA haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.
%K Blood-loss
%K Liver-transplantation
%K Measurement techniques—coagulation
%K Mobile laboratory
%K Point of care testing
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