• E G Pivalizza, D C Abramson, and F S King.
• Department of Anesthesiology, University of Texas Health Science Center, Houston 77030, USA.
• J. Cardiothorac. Vasc. Anesth. 1998 Jun 1;12(3):305-8.

ObjectiveTo investigate the role of heparin in the postreperfusion coagulopathy during liver transplantation with heparinase-guided thromboelastography.DesignA prospective, interventional study.SettingA university-affiliated hospital.ParticipantsTwenty-six patients undergoing orthotopic liver transplantation (OLT).InterventionsBlood 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 ResultsIn 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.ConclusionsHeparinase-treated thromboelastography offered compelling evidence for the presence of heparin-like activity after liver graft reperfusion. The objective evidence provided by this modification of thromboelastography-guided protamine administration and was useful in identifying one of the many potential causes of postreperfusion bleeding in patients undergoing OLT.

25 keywords...

hide…