Viscoelastic Monitoring to Guide Hemostatic Resuscitation in Liver Transplantation Surgery

Kevin P. Blaine, Tetsuro Sakai

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Coagulopathic bleeding must be anticipated during liver transplantation (LT) surgery. Patients with end-stage liver disease (ESLD) often present with disease-related hematologic disturbances, including the loss of hepatic procoagulant and anticoagulant clotting factors and thrombocytopenia. Transplantation surgery itself presents additional hemostatic changes, including hyperfibrinolysis. Viscoelastic monitoring (VEM) is often used to provide targeted, personalized hemostatic therapies for complex bleeding states including cardiac surgery and major trauma. The use in these coagulopathic conditions led to its application to LT, although the mechanisms of coagulopathy in these patients are quite different. While VEM is often used during transplant surgeries in Europe and North America, evidence supporting its use is limited to a few small clinical studies. The theoretical and clinical applications of the standard and specialized VEM assays are discussed in the setting of LT and ESLD.

Original languageEnglish (US)
Pages (from-to)150-163
Number of pages14
JournalSeminars in Cardiothoracic and Vascular Anesthesia
Volume22
Issue number2
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Keywords

  • anesthesiology
  • coagulation
  • review

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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