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  • Title: Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation.
    Author: Kang YG, Martin DJ, Marquez J, Lewis JH, Bontempo FA, Shaw BW, Starzl TE, Winter PM.
    Journal: Anesth Analg; 1985 Sep; 64(9):888-96. PubMed ID: 3896028.
    Abstract:
    The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.
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