Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Feb 1991
Comparative StudyCoagulation disorder during liver transplantation.
Detailed haemostatic changes were investigated during eight liver transplantations. The patients were divided into two groups; group 1 had minor operative bleeding (four cases) and group 2 had major bleeding (four cases). Group 2 had lower levels of platelets, fibrinogen, factor V (FV), and alpha 2-antiplasmin than group 1, and the thromboelastography showed fibrinolysis. ⋯ After revascularization of the graft liver, reductions in the values of PT, fibrinogen, FV and FVII were noted, along with a prolongation of the PTT and an increase in thrombin-antithrombin III complex levels. Plasma levels of protein C, protein S, antithrombin III, and plasminogen remained relatively stable throughout the operation. These results show that the preceding fibrinolysis and subsequent superimposed activation of the clotting system are the main causes of coagulopathy during liver transplantation, which correlate with the amount of operative haemorrhage and the abnormalities found in haemostatic tests.
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Over the past 18 years we have operated on 50 patients who had sustained distal amputation of fingers. Their average age was 30 years (range 2-72 years). Replantation of radial digits on the right hand was most common and the thumb was involved in nearly half the cases in our series. ⋯ If congestion was severe, leeches were used on average for 6 days at a frequency of four to six leeches a day. All cases where leeches were used could be salvaged. One can assess through this sequence that the use of leeches in distal digital replantation has improved the survival rate by 26%.