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REPLACEMENT OF VITAMIN-K DEPENDENT CLOTTING FACTORS IN A PATIENT WITH RETRANSPLANTED LIVER: PRO ET CONTRA
MARIJA MARTINUŠ
; Zagreb University Hospital Center, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb and Varaždin General Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Varaždin, Croatia
MARTINA ČALUŠIĆ
; Zagreb University Hospital Center, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Croatia
TAMARA BIŠKUP PISKAČ
; Zagreb University Hospital Center, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb and Varaždin General Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Varaždin, Croatia
ANITA LUKIĆ
; Zagreb University Hospital Center, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb and Varaždin General Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Varaždin, Croatia
BRUNO MASTEN
; Zagreb University Hospital Center, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb and Varaždin General Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Varaždin, Croatia
SLOBODAN MIHALJEVIĆ
; Zagreb University Hospital Center, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Croatia
Abstract
End-stage liver disease is associated with complex haemostatic system changes. In the course of stable liver disease, this system is ‘rebalanced’ and characterized by reduction in both anticoagulant and procoagulant coagulation factors. During liver transplantation, the rebalanced coagulation system can easily be disrupted by various stress factors (bleeding, hemodynamic instability, tissue damage, large volume resuscitation with blood products) and result in extremely undesirable outcome, bleeding or thrombosis. Current approach in the management of bleeding during liver transplantation involves goaldirected therapy (administration of fi brinogen concentrate and prothrombin complex concentrate (PCC)) guided by dynamic viscoelactic tests of coagulation, e.g., rotational thromboelastometry (ROTEM). Numerous studies have demonstrated reduced perioperative transfusion requirements with such an approach. Hereby, we present a case of a 40-year-old female patient with preexisting partial superior mesenteric vein thrombosis and history of pulmonary embolism, who underwent liver re-transplantation due to relapse of autoimmune hepatitis. Massive bleeding during liver re-transplantation required assive transfusion with the use of PCC intraoperatively to achieve hemostasis. The patient developed graft and portal vein thrombosis on postoperative day 6 and required re-transplantation. Additional studies are needed to determine the effi cacy of PCC application in achieving effective hemostasis and to evaluate its perioperative prothrombotic potential.
Keywords
liver; massive hemorrhage; transplantation; re-transplantation; coagulopathy; hyperfi brinolysis; prothrombin complex concentrate; ROTEM
Hrčak ID:
197902
URI
Publication date:
3.4.2018.
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