移植技術と研究

Thromboelastometric Profile in Patients with Prothrombotic Risk Factors Undergoing Liver Transplantation

Abstract

José Carlos Rodrigues Nascimento, Rodrigo Dornfeld Escalante, David Silveira Marinho, Cláudia Regina Fernandes, Tayná Lima Freire and Aline Menezes Sampaio

Background: Orthotopic liver transplantation (OLT) is a highly complex procedure and can offer difficult intraoperative control in patients with coagulopathy. The present study aimed to evaluate the profile of coagulation by Rotation thromboelastometry (ROTEM®) in the intraoperative of patients with prothrombotic risk factors submitted to liver transplantation. Methods: A prospective, observational pilot study, in which 24 patients submitted to OLT, of both sexes and age from 18 years, were included in the period from October 2014 to June 2017. Three samples were taken intraoperatively to analyze the profile of coagulation through the thromboelastometry assays (EXTEM, FIBTEM, INTEM and HEPTEM). Results: In the analysis of the tests in the EXTEM (clotting time [CT] and maximum clot firmness [MCF]) and INTEM (MCF), there was hypocoagulation along the OLT, with no statistical difference between the values obtained. In the FIBTEM tests (amplitude in 10 minutes [A10] and MCF),There was reduction in the neohepatic phase (stage III) in relation to the beginning of surgery (stage I), with statistical significance (P=0.0424 and 0.0227, respectively). In the analysis of CT in the INTEM, there was an increase in the stage III in relation to stage I and anhepatic phase (stage II), with statistical significance (P=0.0004 and 0.0012, respectively). The fibrinolytic activity by maximum lysis (ML) was higher in the stage I and stage II in relation to stage III, when analyzed by the EXTEM, presenting statistical significance (P=0.0016 and 0.0035, respectively). Conclusion: In patients with prothrombotic risk factors, data from the ROTEM® analysis showed some statistically significant changes, but we cannot say that it showed tendency to hypocoagulation, when there was not significance in most other tests. Therefore, in the FIBTEM tests the consumption of fibrinogen was more accentuated in stage III in relation to stage I and in relation to stage III, when analyzed by INTEM CT and EXTEM ML, the presence of heparin was higher and fibrinolysis was less pronounced, respectively.