دورية أكاديمية
Implementation of a Bleeding Management Algorithm in Liver Transplantation: A Pilot Study.
العنوان: | Implementation of a Bleeding Management Algorithm in Liver Transplantation: A Pilot Study. |
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المؤلفون: | Sarmiento IA; Department of Anesthesiology, Clínica Santa María, Santiago de Chile, Chile., Guzmán MF; Department of Anesthesiology, Universidad de los Andes, Santiago de Chile, Chile., Chapochnick J; Department of Surgery, Clínica Santa María, Santiago de Chile, Chile., Meier J; Department for Anesthesiology and Critical Care, Kepler University Hospital, Johannes Kepler University, Linz, Austria. |
المصدر: | Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie [Transfus Med Hemother] 2023 Aug 03; Vol. 51 (1), pp. 1-11. Date of Electronic Publication: 2023 Aug 03 (Print Publication: 2024). |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: S. Karger Country of Publication: Switzerland NLM ID: 101176417 Publication Model: eCollection Cited Medium: Print ISSN: 1660-3796 (Print) Linking ISSN: 16603796 NLM ISO Abbreviation: Transfus Med Hemother Subsets: PubMed not MEDLINE |
أسماء مطبوعة: | Original Publication: Basel ; New York : S. Karger, c2003- |
مستخلص: | Objectives: The aims of the study were to compare the consumption of blood products before and after the implementation of a bleeding management algorithm in patients undergoing liver transplantation and to determine the feasibility of a multicentre, randomized study. Background: Liver transplantation remains the only curative therapy for patients with end-stage liver disease, but it carries a high risk of surgical bleeding. Materials and Methods: Retrospective study of patients treated before (group 1) and after (group 2) implementation of a haemostatic algorithm guided by viscoelastic testing, including use of lyophilized coagulation factor concentrates ( prothrombin complex and fibrinogen concentrates ). Primary outcome was the number of units of blood products transfused in 24 h after surgery. Secondary outcomes included hospital stay, mortality, and cost. Results: Data from 30 consecutive patients was analysed; 14 in group 1 and 16 in group 2. Baseline data were similar between groups. Median total blood product consumption 24 h after surgery was 33 U (IQR: 11-57) in group 1 and 1.5 (0-23.5) in group 2 ( p = 0.028). Significantly fewer units of red blood cells, fresh frozen plasma, and cryoprecipitate were transfused in group 2 versus group 1. There was no significant difference in complications, hospital stay, or in-hospital mortality between groups. The cost of haemostatic therapy was non-significantly lower in group 2 versus group 1 (7,400 vs. 15,500 USD; p = 0.454). Conclusion: The haemostatic management algorithm was associated with a significant reduction in blood product use during 24 h after liver transplantation. This study demonstrated the feasibility and provided a sample size calculation for a larger, randomized study. Competing Interests: I.A.S. reports personal fees and non-financial support from Octaphama and Werfen, outside the submitted work. M.F.G., J.C., and J.M. have no conflicts of interest to declare. (© 2023 The Author(s). Published by S. Karger AG, Basel.) |
References: | JAMA. 2019 Nov 26;322(20):1966-1976. (PMID: 31634905) Gastroenterol Clin North Am. 1988 Mar;17(1):33-51. (PMID: 3292430) Anesth Analg. 2020 Jul;131(1):74-85. (PMID: 32243296) Transplantation. 2018 Apr;102(4):578-592. (PMID: 29337842) World J Gastroenterol. 2014 May 28;20(20):6146-58. (PMID: 24876736) Lancet Gastroenterol Hepatol. 2023 Jan;8(1):81-94. (PMID: 36495912) Clin Chem Lab Med. 2019 May 27;57(6):883-890. (PMID: 30530897) J Thromb Haemost. 2018 Feb;16(2):253-261. (PMID: 29220876) Clin Transplant. 2018 Dec;32(12):e13435. (PMID: 30375084) Korean J Anesthesiol. 2011 Mar;60(3):151-60. (PMID: 21490815) J Cardiothorac Vasc Anesth. 2016 Oct;30(5):1196-204. (PMID: 27493092) Transplant Direct. 2015 Dec 15;2(1):e49. (PMID: 27500243) J Thromb Haemost. 2022 Jan;20(1):39-47. (PMID: 34661370) Platelets. 2014;25(8):576-86. (PMID: 24246132) Liver Transpl. 2011 Feb;17(2):149-58. (PMID: 21280188) Eur J Anaesthesiol. 2019 Nov;36(11):825-833. (PMID: 31567574) BMC Anesthesiol. 2019 Jun 11;19(1):97. (PMID: 31185916) Minerva Anestesiol. 2018 Apr;84(4):447-454. (PMID: 29108404) Transfusion. 2017 Dec;57(12):3026-3034. (PMID: 28960322) N Engl J Med. 2022 May 26;386(21):1986-1997. (PMID: 35363452) Korean J Anesthesiol. 2019 Aug;72(4):297-322. (PMID: 31096732) Transpl Int. 2005 Jan;17(11):673-9. (PMID: 15717214) Ann Hepatol. 2017 Oct 16;16(6):916-923. (PMID: 29055918) N Engl J Med. 2017 Oct 12;377(15):1485-1488. (PMID: 29020590) J Am Coll Surg. 2013 May;216(5):902-7. (PMID: 23478547) Crit Care Med. 2020 Mar;48(3):415-419. (PMID: 32058375) JAMA Netw Open. 2021 Apr 1;4(4):e213936. (PMID: 33792729) Transfusion. 2019 Nov;59(11):3295-3297. (PMID: 31267541) N Engl J Med. 2013 Aug 1;369(5):428-37. (PMID: 23902482) Liver Transpl. 2003 Dec;9(12):1320-7. (PMID: 14625833) Transplant Proc. 2016 Dec;48(10):3303-3306. (PMID: 27931573) J Thromb Haemost. 2010 Jan;8(1):202-4. (PMID: 19878532) Exp Clin Transplant. 2016 Aug;14(4):405-11. (PMID: 27506259) Cochrane Database Syst Rev. 2011 Dec 07;(12):CD009052. (PMID: 22161443) Transplant Proc. 2015 Dec;47(10):2925-8. (PMID: 26707315) Exp Clin Transplant. 2019 Apr;17(2):222-230. (PMID: 30295585) Liver Transpl. 2006 Nov;12(11):1584-93. (PMID: 16952177) Eur J Gastroenterol Hepatol. 2020 Nov;32(11):1452-1457. (PMID: 32118854) J Thromb Haemost. 2020 Feb;18(2):352-363. (PMID: 31654548) Liver Transpl. 2015 Feb;21(2):169-79. (PMID: 25331016) Eur J Anaesthesiol. 2017 Jun;34(6):332-395. (PMID: 28459785) Am J Transplant. 2012 Oct;12(10):2789-96. (PMID: 22823098) Transfusion. 2014 Oct;54(10 Pt 2):2760-8. (PMID: 24827116) |
فهرسة مساهمة: | Keywords: Bleeding; Haemostasis; Liver transplant; Viscoelastic testing |
تواريخ الأحداث: | Date Created: 20240205 Latest Revision: 20240206 |
رمز التحديث: | 20240206 |
مُعرف محوري في PubMed: | PMC10836948 |
DOI: | 10.1159/000530579 |
PMID: | 38314241 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1660-3796 |
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DOI: | 10.1159/000530579 |