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The effect of a viscoelastic-guided bleeding algorithm implementation on blood products use in adult liver transplant patients. A propensity score-matched before-after study

Published:November 16, 2021DOI:https://doi.org/10.1016/j.transci.2021.103322

      Highlights

      • Bleeding management algorithms are often used in liver transplant (LTx).
      • A structured bleeding algorithm use allows a more restrictive transfusion strategy.
      • Viscoelastic tests reveal the complex hemostatic changes of cirrhotic patients.
      • Coagulopathy in LTx is assessed better with viscoelastic tests than standard tests.
      • Guidance by viscoelastic tests led to decreased use of blood products in LTx.

      Abstract

      Background

      Perioperative blood products transfusion is correlated with increased morbidity and mortality in liver transplantation (LTx). The objectives of our study are to assess the effect of a standardized viscoelastic test (VET)-guided bleeding management algorithm implementation on intraoperative bleeding, allogenic blood products and factor concentrates requirements and on early postoperative complications in LTx.

      Methods

      Retrospective before-after study comparing two matched cohorts of patients undergoing LTx before (control cohort) and after (intervention cohort) the implementation of a VET-based bleeding algorithm in a single center academic hospital.

      Results

      After propensity score matching, we included 94 patients in each cohort. Patients in intervention cohort received significantly less blood products, fresh frozen plasma (FFP), and cryoprecipitate (p < 0.001 for each), while the amount of fibrinogen concentrate used was significantly higher (p < 0.001). Postoperatively, intervention cohort patients had significantly lower postoperative hemoglobin and fibrinogen levels and longer prothrombin time compared to control cohort. There were no significant differences in red blood cells transfusions, intraoperative bleeding, early postoperative complications, and short term survival.

      Conclusions

      The implementation of a VET-guided bleeding algorithm decreases allogenic blood products requirements, mainly FFP use and allows a more restrictive management of coagulopathy in patients with chronic liver disease undergoing LTx.

      Keywords

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