The Optimal Transfusion Strategy in Liver Transplantation:

The Quest Continues 

Autores: Intagliata Nicolas M, Northup Patrick G, Caldwell Stephen H

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Smart, et al. Rotational Thromboelastometry or Conventional Coagulation Tests in Liver Transplantation: Comparing Blood Loss, Transfusions, and Cost. Annals of Hepatology. The physiology of hemostasis in decompensated cirrhosis is profoundly distinct from any other disease state encountered during surgery. Our current understanding of the coagulation system in cirrhosis has expanded significantly over the last 15 years.1,2 This new paradigm relies entirely on the concept of a rebalanced coagulation state, where all of the components of the system are significantly altered (both pro and anticoagulant portions), but maintained in a precarious equilibrium. External disruption of this balance, whether a consequence of disease progression or from human intervention, can thrust the balance into bleeding or thrombosis, often in dramatic fashion. Liver transplantation represents one of the greatest physiological insults to this balance. In the perioperative period, both bleeding or thrombosis can be catastrophic, which imbues a strong impulse to aim all measures at prevention. However, without an adequate measure to provide guidance, current efforts at prophylactic therapy are often misguided and potentially counter-productive. Particularly transfusion of large volumes of blood product (excessive use of fresh frozen plasma (FFP)) can only serve to potentiate portal hypertension and beget a vicious cycle of bleeding.

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2017-12-13   |   348 visitas   |   1 valoraciones

Vol. 16 Núm.6. Noviembre-Diciembre 2017 Pags. 828-829 Ann Hepatol 2017; 16(6)