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Different incidence of preoperative and postreperfusion hyperfibrinolysis using ML>15% criteria compared to DMCF criteria ML> 15% criteria= hyperfibrinolysis defined as maximum lysis higher than 15% DMCF criteria= hyperfibrinolysis defined as difference in clot amplitude between APTEM and EXTEM higher than 7% of EXTEM
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Introduction Hyperfibrinolysis is often encountered in liver transplant procedures and can be associated with coagulopathic bleeding and increased transfusion requirements [1]. Recent data shows that some of the patients that will develop hyperfibrinolysis during liver transplantation can be identified by the use of preoperative thromboelastometry,...
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Background
Congenital fibrinogen deficiency (CFD) is a rare bleeding disorder characterized by reduced levels (afibrinogenemia, hypofibrinogenemia) or dysfunctional fibrinogen (dysfibrinogenemia), for which fibrinogen supplementation is the mainstay treatment.
Objectives
To assess the efficacy and safety of human fibrinogen concentrate (FCH) in pa...
Citations
... In 2011 TEG/ROTEM could not be recommended for LYX due to the lack of evidence of benefits in outcomes (10) . Despite this, the use of TEG/ROTEM has expanded and new clinical studies have emerged (11,12,13,14,15,16,17,18) . The recommendations we made in 2011 need to be update. ...
The accuracy of the TEG/ROTEM as diagnostic test has been proved(19) and systematic reviews were performed to aggregate the evidence from different clinical scenarios (mainly cardiac surgery). Assess the impact of the intraoperative point of care use of TEG or ROTEM versus conventional coagulation tests (CCT) on the blood components transfusion, bleeding, complications, mortality, hospitalization and costs during adult LTX surgeries. I used PICOS framework to establish the research questions (objectives section) and the inclusion criteria. Type of studies included. The eligibility criteria were randomized controlled trials and non-randomized controlled trials (RCTs and non-RCTs). Primary outcomes: mortality at maximal follow up, allogeneic transfusion requirements: packaged red cells (PRC), platelets, fresh frozen plasma(FFP), cryoprecipitates), complications (medical adverse event that may be related to the coagulation status). Secondary outcomes: blood loss (however measured by authors), total hospital stays, intensive care unit (ICU) stay, costs (of the transplant surgery or of the patient in-hospital treatment). A total of 183 studies were identified and a PRISMA-based diagram was constructed and 8 of them were selected to assess. Six articles were found in full text and were screened for inclusion and exclusion criteria. Five trials had the selected outcomes and inclusion criteria and the quality was assessed with a critical appraisal approach to identify bias and confounders. In conclusion, TEG/ROTEM directed blood products replacement in LTX might be effective in reducing FFP transfusion during the intraoperative. Further studies are required to confirm this finding and to assess the overall requirements of other blood products, bleeding mortality and complications.
