Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis
Liver transplantation (LT) is a serious hemostatic challenge in patients with portal vein thrombosis (PVT). Advances in monitoring systems have improved surgery in this setting. We report the successful application of a point-of-care (POC) rotational viscoelastic thromboelastometry-guided (TEM) test...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2014/487364 |
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| author | Cristiano Piangatelli Lucia Faloia Claudia Cristiani Ilaria Valentini Marco Vivarelli |
| author_facet | Cristiano Piangatelli Lucia Faloia Claudia Cristiani Ilaria Valentini Marco Vivarelli |
| author_sort | Cristiano Piangatelli |
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| description | Liver transplantation (LT) is a serious hemostatic challenge in patients with portal vein thrombosis (PVT). Advances in monitoring systems have improved surgery in this setting. We report the successful application of a point-of-care (POC) rotational viscoelastic thromboelastometry-guided (TEM) testing system (ROTEM) which allowed management of coagulation during LT in a 64-year-old cirrhotic patient with a model for end-stage liver disease (MELD) score of 16. Perioperatively, the patient showed complete PVT, hepatomegaly, splenomegaly, recanalization of the umbilical vein, and portosystemic shunt. Macroscopic liver and spleen adherences with collateral circulation were evident. Coagulation factors and fibrinolysis were assessed preoperatively and at graft reperfusion to evaluate the need of hemostatic therapy. Based on ROTEM findings, the patient received 16 g of human fibrinogen concentrate, half preoperatively (with prothrombin complex concentrate 2000 IU, tranexamic acid 1 g, and platelets 2 IU), and two doses of 4 g before and after graft reperfusion; we achieved normalization of all monitored parameters. No ischemia-reperfusion syndrome was present. Postoperatively portal vein flux at Color-Doppler ultrasonography was normal. After a 3-day ICU stay, the patient was moved to the Department of Surgery and discharged on day 14. The postoperative course was uneventful and did not require any further haemostatic therapy. |
| format | Article |
| id | doaj-art-b99de28fe7604a3db609a7690ff6d049 |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-b99de28fe7604a3db609a7690ff6d0492025-02-03T06:42:03ZengWileyCase Reports in Transplantation2090-69432090-69512014-01-01201410.1155/2014/487364487364Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein ThrombosisCristiano Piangatelli0Lucia Faloia1Claudia Cristiani2Ilaria Valentini3Marco Vivarelli4Division of Anaesthesia and Resuscitation, Department of Emergency, Ospedali Riuniti, Via Conca 71, 60020 Ancona, ItalyDepartment of Emergency, Anesthesia and Resuscitation Unit, Università Politecnica delle Marche, Via Conca 71, 60020 Ancona, ItalyDivision of Anaesthesia and Resuscitation, Department of Emergency, Ospedali Riuniti, Via Conca 71, 60020 Ancona, ItalyDivision of Anaesthesia and Resuscitation, Department of Emergency, Ospedali Riuniti, Via Conca 71, 60020 Ancona, ItalyDepartment of Liver Surgery and Transplantation, Ospedali Riuniti, Via Conca 71, 60020 Ancona, ItalyLiver transplantation (LT) is a serious hemostatic challenge in patients with portal vein thrombosis (PVT). Advances in monitoring systems have improved surgery in this setting. We report the successful application of a point-of-care (POC) rotational viscoelastic thromboelastometry-guided (TEM) testing system (ROTEM) which allowed management of coagulation during LT in a 64-year-old cirrhotic patient with a model for end-stage liver disease (MELD) score of 16. Perioperatively, the patient showed complete PVT, hepatomegaly, splenomegaly, recanalization of the umbilical vein, and portosystemic shunt. Macroscopic liver and spleen adherences with collateral circulation were evident. Coagulation factors and fibrinolysis were assessed preoperatively and at graft reperfusion to evaluate the need of hemostatic therapy. Based on ROTEM findings, the patient received 16 g of human fibrinogen concentrate, half preoperatively (with prothrombin complex concentrate 2000 IU, tranexamic acid 1 g, and platelets 2 IU), and two doses of 4 g before and after graft reperfusion; we achieved normalization of all monitored parameters. No ischemia-reperfusion syndrome was present. Postoperatively portal vein flux at Color-Doppler ultrasonography was normal. After a 3-day ICU stay, the patient was moved to the Department of Surgery and discharged on day 14. The postoperative course was uneventful and did not require any further haemostatic therapy.http://dx.doi.org/10.1155/2014/487364 |
| spellingShingle | Cristiano Piangatelli Lucia Faloia Claudia Cristiani Ilaria Valentini Marco Vivarelli Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis Case Reports in Transplantation |
| title | Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis |
| title_full | Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis |
| title_fullStr | Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis |
| title_full_unstemmed | Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis |
| title_short | Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis |
| title_sort | point of care perioperative coagulation management in liver transplantation and complete portal vein thrombosis |
| url | http://dx.doi.org/10.1155/2014/487364 |
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