Effect of magnesium on rotational thromboelastometry (ROTEM) and total blood products requirement in patients undergoing liver transplantation

AbstractObjectivesTo provide an overview of the clot viscoelastic testing technology and to describe its utility in guiding blood product transfusions.MethodsA case scenario will be discussed as well as interpretation of thromboelastography (TEG) tracings. In addition, literature examining the utility of viscoelastic testing in guiding patient management and blood product transfusions will be reviewed.ResultsTEG/rotational thromboelastometry (ROTEM) is useful in evaluating clot kinetics in trauma and acutely bleeding patients. TEG/ROTEM parameters are reflective of values measured using standard coagulation assays; however, TEG/ROTEM parameters are more rapidly available and more costly. TEG and ROTEM are used in three main settings: cardiac surgery, liver transplantation, and trauma to assess global hemostasis and administration of blood products.ConclusionsTEG/ROTEM can be helpful in guiding resuscitation and blood product transfusion. Several studies have demonstrated a reduction in transfusion of blood components with TEG/ROTEM; however, other studies have suggested that TEG/ROTEM is not clinically effective in guiding transfusion.

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Rotational Thromboelastometry (ROTEM) TRUE-NATEM Reference Value Validation in Liver Transplantation

Case Medical Research ◽

10.31525/ct1-nct04282889 ◽

2020 ◽

Author(s):

Keyword(s):

Liver Transplantation ◽

Reference Value ◽

Rotational Thromboelastometry

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Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study

Journal of Perioperative Practice ◽

10.1177/1750458920950662 ◽

2021 ◽

pp. 175045892095066

Author(s):

Minna Kallioinen ◽

Mika Valtonen ◽

Marko Peltoniemi ◽

Ville-Veikko Hynninen ◽

Tuukka Saarikoski ◽

...

Keyword(s):

Cardiac Surgery ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Rotational Thromboelastometry ◽

Number Of Patients ◽

Fresh Frozen ◽

The Mean ◽

To Receive ◽

Frozen Plasma

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

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Aprotinin reduces the need for blood products during liver transplantation

The American Journal of Surgery ◽

10.1016/s0002-9610(99)80215-3 ◽

1995 ◽

Vol 169 (5) ◽

pp. 546-549 ◽

Cited By ~ 24

Author(s):

Charles H. Scudamore ◽

Thomas E. Randall ◽

Peter J. Jewesson ◽

Christopher R. Shackleton ◽

Anthony J. Salvian ◽

...

Keyword(s):

Liver Transplantation ◽

Blood Products

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Massive Transfusion in a Child

10.1093/med/9780190678333.003.0020 ◽

2018 ◽

Author(s):

Rachel Chapman ◽

Stefano Sabato

Keyword(s):

At Risk ◽

Liver Transplantation ◽

Blood Transfusion ◽

Blood Loss ◽

Massive Transfusion ◽

Vascular Structure ◽

Blood Products ◽

Process Knowledge ◽

Massive Blood Transfusion ◽

Laboratory Results

Massive transfusion in a child is likely to occur in cases of trauma or during surgeries that are at risk for severe blood loss such as liver transplantation and craniofacial procedures. It may also occur when least expected, if inadvertent injury to a vascular structure occurs during surgery. Ability to enlist assistance with administration of the various blood products required and also with checking frequent laboratory results will facilitate the process. Knowledge of the different factors that rapidly become depleted as well as lab values that need to be closely monitored is necessary to avoid further complications during massive blood transfusion.

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Liver Transplant

10.1093/med/9780199764495.003.0027 ◽

2013 ◽

Author(s):

Ximena Soler ◽

Lori A Aronson ◽

Gillian Derrick

Keyword(s):

Liver Transplantation ◽

Blood Loss ◽

Liver Failure ◽

Liver Transplant ◽

Orthotopic Liver Transplantation ◽

Massive Hemorrhage ◽

Blood Products ◽

End Stage

Liver transplantation is an established therapy in pediatric end-stage liver failure. Blood loss during orthotopic liver transplantation (OLT) is highly variable. Massive hemorrhage and transfusion of blood products, with its related consequences, is a well-known complication of this operation.

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Analysis of the hemostatic therapy in liver transplantation guided by rotational thromboelastometry or conventional laboratory tests

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000001660 ◽

2020 ◽

Vol 32 (11) ◽

pp. 1452-1457 ◽

Cited By ~ 1

Author(s):

Jose C.R. Nascimento ◽

Edson B.L. Neto ◽

Eliana L. da Silva ◽

Rogean R. Nunes ◽

David S. Marinho ◽

...

Keyword(s):

Liver Transplantation ◽

Laboratory Tests ◽

Rotational Thromboelastometry ◽

Hemostatic Therapy

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From ER to OR: Results After Implementation of Multidisciplinary Pathway for Fragility Hip Fractures at a Level I Trauma Center

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320927383 ◽

2020 ◽

Vol 11 ◽

pp. 215145932092738

Author(s):

Kenoma Anighoro ◽

Carla Bridges ◽

Alexander Graf ◽

Alexander Nielsen ◽

Tannor Court ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Trauma Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Blood Products ◽

Total Blood ◽

Fragility Hip Fracture ◽

Level I

Introduction: Hip fractures are one of the most common indications for hospitalization and orthopedic intervention. Fragility hip fractures are frequently associated with multiple comorbidities and thus may benefit from a structured multidisciplinary approach for treatment. The purpose of this article was to retrospectively analyze patient outcomes after the implementation of a multidisciplinary hip fracture pathway at a level I trauma center. Materials and Methods: A retrospective review of 263 patients over the age of 65 with fragility hip fracture was performed. Time to surgery, hospital length of stay, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists, complication rates, and other clinical outcomes were compared between patients treated in the year before and after implementation of a multidisciplinary hip fracture pathway. Results: Timing to OR, hospital length of stay, and complication rates did not differ between pre- and postpathway groups. The postpathway group had a greater CCI score (pre: 3.10 ± 3.11 and post: 3.80 ± 3.18). Fewer total blood products were administered in the postpathway group (pre: 1.5 ± 1.8 and post: 0.8 ± 1.5). Discussion: The maintenance of clinical outcomes in the postpathway cohort, while having a greater CCI, indicates the same quality of care was provided for a more medically complex patient population. With a decrease in total blood products in the postpathway group, this highlights the economic importance of perioperative optimization that can be obtained in a multidisciplinary pathway. Conclusion: Implementation of a multidisciplinary hip fracture pathway is an effective strategy for maintaining care standards for fragility hip fracture management, particularly in the setting of complex medical comorbidities.

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