| Title |
Viscoelastic hemostasis testing to guide transfusion decisions in liver transplantation / |
| Translation of Title |
Viscoelastic Hemostasis Testing to Guide Transfusion Decisions in Liver Transplantation. |
| Authors |
Fritz, Suna Manolya |
| Full Text |
|
| Pages |
65 |
| Keywords [eng] |
Adult orthotopic liver transplantation, Viscoelastic testing, VET, Rotational thromboelastometry, ROTEM, Thromboelastography, TEG, Hemostatic monitoring, VET-guided transfusion, Blood transfusion, Patient blood management |
| Abstract [eng] |
Implementing the World Health Organization’s 2021 “patient blood management” (1) encouraged research about the value of viscoelastic tests in the diagnosis and treatment of coagulopathies during liver transplantation. This thesis aims to review evidence and challenges regarding the predictive value and effect of viscoelastic tests on patient outcomes and blood product requirements when guiding transfusion decisions in liver transplantation, compared to standard care under conventional coagulation tests. The determination and implementation of transfusion thresholds will be discussed. PubMed search included literature from January 2017 to January 2024. Viscoelastic test-based transfusion strategies increase rates of transfusion-free liver transplantation. They reduce platelet concentrate and fresh frozen plasma requirements, without increasing perioperative complications. Prothrombin complex concentrate and/or fibrinogen concentrate use for factor replacement increase. Likewise, the total fibrinogen administration is higher, without augmenting thrombotic complications. Evidence is ambiguous about whether fibrinogen concentrate or cryoprecipitate is preferable for fibrinogen substitution. The implication on cryoprecipitate requirement remains to be investigated. Intraoperative bleeding volume and red blood cell requirement are indistinguishable between transfusion strategies. Recombinant factor 7a is not recommended. Transfusion-related acute lung injury and costs may be reduced through viscoelastic testing. Long-term mortality, graft dysfunction, reoperations, bleeding and length of stay are comparable. Short-term mortality and acute kidney injury are strongly variable among studies. Viscoelastic tests’ predictive value lies within the risk assessment for massive transfusion events. A major problem for research and formulation of transfusion algorithms comprises the lacking validation of viscoelastic thresholds and further methodological challenges, limiting study comparability and quality of evidence. |
| Dissertation Institution |
Vilniaus universitetas. |
| Type |
Master thesis |
| Language |
English |
| Publication date |
2024 |
