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Minerva Anestesiologica 2014 May;80(5):568-73

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

Low plasma fibrinogen levels and blood product transfusion in liver transplantation

Costa M., Dalmau A., Sabate A., Koo M., Aparicio I., Contreras L.

Department of Anesthesia and Resuscitation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain


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BACKGROUND: Risk of bleeding in liver transplantation is determined by surgical technique, preoperative hemoglobin and antifibrinolitic therapy. We hypothesized that keeping these confounders factors identical, preoperative plasma fibrinogen level of ≤2 g/L influenced on blood product requirements.
METHODS: Adult patients underwent orthotropic liver transplantation (LT) during the period between January 1998 and December 2009. Cases were selected according to a propensity matching analysis meeting the following criteria: surgical vena cava preservation, tranexamic acid administration and hemoglobin range between 90 to 120 g/L. Intraoperative management was protocolized. The main variable was the percentage of patients that did not require red blood cells (RBC’s).
RESULTS: Six hundred sixty-four patients with LT, 208 excluded, 266 who cannot be matched, the analysis was performed on 190 patients. Two cohorts: Low fibrinogen (≤2 g/L) (61 cases) and standard fibrinogen (>2 g/L) (129 cases) were analyzed. Preoperative platelet count (73.5±52 vs. 104±65; 103/mm3) was different in contrast to the hemoglobin (104.2±8.6 vs. 105.6±8.3; g/L). Use of RBC’s resulted significantly higher in the low fibrinogen group (median, 3 vs. 2). The number of patients with no blood product requirements was fewer in the low fibrinogen group (8 cases, 13% vs. 45 cases, 35%). The critical level of plasma fibrinogen (1 g/L) was reached after graft reperfusion in 7 cases (5.5%) in the standard fibrinogen group vs. 24 cases (39%) in the low fibrinogen group.
CONCLUSION: Our data suggest that preoperative plasma fibrinogen level of ≤2 g/L increases requirements for blood products during the surgical procedure of liver transplantation.

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