Thromboelastography with heparinase in orthotopic liver transplantation

• Published in: Journal of cardiothoracic and vascular anesthesia 1998-06, Vol.12 (3), p.305-308
• Main Authors: Pivalizza, Evan G., Abramson, David C., King, Frank S.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Coagulation - drug effects; Blood Coagulation - physiology; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - drug therapy; Female; Follow-Up Studies; heparin; Heparin - physiology; Heparin Antagonists - administration & dosage; Heparin Lyase - administration & dosage; heparinase; Humans; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; orthotopic liver transplantation; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - drug therapy; Prospective Studies; Protamines - administration & dosage; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thrombelastography; thromboelastography
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(98)90011-8

Objective: To investigate the role of heparin in the postreperfusion coagulopathy during liver transplantation with heparinase-guided thromboelastography. Design: A prospective, interventional study. Setting: A university-affiliated hospital. Participants: Twenty-six patients undergoing orthotopic liver transplantation (OLT). Interventions: Blood drawn at five intervals for thromboelastography assessment with native (12 patients) or celite blood (14 patients) compared with simultaneous thromboelastography traces with added heparinase. Main Results: In the native samples, the prolonged R (reaction) and K (coagulation) time and decreased alpha angle were corrected in heparinase thromboelastograph traces immediately before reperfusion and 10 minutes postreperfusion. In the celite-accelerated samples, the heparinase traces showed correction of the R and K times and alpha angle only at the 10-minute postreperfusion stage. In seven patients who had thromboelastography performed after protamine administration, there were no differences between celite and heparinase-celite traces. Conclusions: Heparinase-treated thromboelastography offered compelling evidence for the presence of heparin-like activity after liver graft reperfusion. The objective evidence provided by this modification of thromboelastographyguided protamine administration and was useful in identifying one of the many potential causes of postreperfusion bleeding in patients undergoing OLT.