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Review
. 2023 Dec 1;28(6):404-411.
doi: 10.1097/MOT.0000000000001101. Epub 2023 Sep 18.

Coagulation management during liver transplantation: monitoring and decision making for hemostatic interventions

Kofi B Vandyck  1 , Walter Rusin  1 , Samhati Mondal  2 , Kenichi A Tanaka  1
Affiliations
Review

Coagulation management during liver transplantation: monitoring and decision making for hemostatic interventions

Kofi B Vandyck et al. Curr Opin Organ Transplant. .

Abstract

Purpose of review: Rebalanced hemostasis describes the precarious balance of procoagulant and antithrombotic proteins in patients with severe liver failure. This review is aimed to discuss currently available coagulation monitoring tests and pertinent decision-making process for plasma coagulation factor replacements during liver transplantation (LT).

Recent findings: Contemporary viscoelastic coagulation monitoring systems have demonstrated advantages over conventional coagulation tests in assessing the patient's coagulation status and tailoring hemostatic interventions. There is increasing interest in the use of prothrombin complex and fibrinogen concentrates, but it remains to be proven if purified factor concentrates are more efficacious and safer than allogeneic hemostatic components. Furthermore, the decision to use antifibrinolytic therapy necessitates careful considerations given the risks of venous thromboembolism in severe liver failure.

Summary: Perioperative hemostatic management and thromboprophylaxis for LT patients is likely to be more precise and patient-specific through a better understanding and monitoring of rebalanced coagulation. Further research is needed to refine the application of these tools and develop more standardized protocols for coagulation management in LT.

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References

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