RT Journal Article
T1 Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome
A1 Leon-Justel, Antonio
A1 Noval-Padillo, Jose A.
A1 Alvarez-Rios, Ana I.
A1 Mellado, Patricia
A1 Gómez-Bravo, Miguel Ángel
A1 Alamo, Jose M.
A1 Porras, Manuel
A1 Barrero, Lydia
A1 Hinojosa, Rafael
A1 Carmona, Magdalena
A1 Vilches-Arenas, Angel
A1 Guerrero, Juan M.
K1 Blood-loss
K1 Liver-transplantation
K1 Measurement techniques—coagulation
K1 Mobile laboratory
K1 Point of care testing
AB 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.
PB Elsevier
YR 2015
FD 2015-04-25
LK https://hdl.handle.net/10668/23208
UL https://hdl.handle.net/10668/23208
LA en
NO Leon-Justel A, Noval-Padillo JA, Alvarez-Rios AI, Mellado P, Gómez-Bravo MA, Alamo JM et al. Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome. Clin Chim Acta. 2015 Jun 15;446:277-83.
DS RISalud
RD Apr 8, 2025