[The thromboelastometric criteria of hemostasis disorders correction during liver transplantation]

Abstract

The purpose of the study. Optimum correction of hemostasis remains one of the unsolved problems in anesthesia maintenance during liver transplantation. Modern methods of coagulation monitoring (thromboelastography, thromboelastometry) allows to differ the increased bleeding reason. The clear criteria for the appointment of the blood components according to these methods have not developed so far. The aim of this study was to determine the criteria of hemostasis disorders correction during liver transplantation.

Materials and methods: The study included all patients undergoing a liver transplantation in our clinic from January 2009 to December 2010. In certain intervals of time an intake of blood samples for the hemostasis study including koagulogramm, determination of the clotting factors and natural anticoagulants activity was performed.

Results: There is no significant correlation between the results of the standard coagulation tests and thromboelastometry Based on the international hemostasis correction recommendations, with the help of ROC-analysis the search for thromboelastometry data, which would have pointed to the need for this therapy was made. Concerning coagulation factors deficiency (INR>2, APTT> 1.5) CT-EXTEM>80 has a sensitivity of 17% and a specificity of 97%, and CT-INTEM>240 has sensitivity of 51% and specificity of 96%. Use of A10-FIBTEM for fibrinogen deficiency diagnosis, A10-FIBTEM <9 has sensitivity of 95% and specificity of 63%. A simultaneous increase of CT-EXTEM >80 and CT-INTEM more than 300 has a sensitivity of 96% and a specificity 81% in relation to diagnose thrombocytopenia (platelet count less than 50,000 per mcl).

Conclusion: Correction of coagulation factors deficiency indicated when CT-EXTEM>80 and CT-INTEM> 240, hypofibrinogenemia when A10-FIBTEM <9, thrombocytopenia when of CT-EXTEM >80 and CT-INTEM increase simultaneously more than 300.