Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report
Abstract Introduction: Advanced hepatic disease may - in addition to the widely recognized hemorrhagic complications - occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastom...
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| Format: | Article |
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Sociedade Brasileira de Anestesiologia
2018-11-01
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| Series: | Revista Brasileira de Anestesiologia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000600645&tlng=en |
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| author | José Carlos Rodrigues Nascimento David Silveira Marinho Rodrigo Dornfeld Escalante Bodiyabaduge Emmanuel M. Daya Pereira Junior Cristiane Gurgel Lopes Rogean Rodrigues Nunes |
| author_facet | José Carlos Rodrigues Nascimento David Silveira Marinho Rodrigo Dornfeld Escalante Bodiyabaduge Emmanuel M. Daya Pereira Junior Cristiane Gurgel Lopes Rogean Rodrigues Nunes |
| author_sort | José Carlos Rodrigues Nascimento |
| collection | DOAJ |
| description | Abstract Introduction: Advanced hepatic disease may - in addition to the widely recognized hemorrhagic complications - occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastometry (ROTEM®). Case report: A 56 year-old male patient diagnosed with alcohol cirrhosis using warfarin (2.5 mg.day−1) for partial portal vein thrombosis with the International Normalized Ratio (INR) of 2.14. At the beginning of surgery, the ROTEM® parameters were all normal. In the anhepatic phase, EXTEM and INTEM remained normal, but FIBTEM showed reduction of amplitude after 10 min and maximum clot firmness. Finally, in the neohepatic phase, there was a slight alteration in the hypocoagulability of most of the parameters of the EXTEM, INTEM and FIBTEM, besides a notable correction of the Coagulation Time (CT) in HEPTEM compared to the CT of the INTEM. Therefore, the patient did not receive any transfusion of blood products during surgery and in the postoperative period, being discharged on the 8th postoperative day. Discussion: Coagulation deficit resulting from cirrhosis distorts INR as a parameter of anticoagulation adequacy and as a determinant of the need for blood transfusion. Thus, thromboelastometry can provide important information for patient management. |
| first_indexed | 2024-12-18T02:32:50Z |
| format | Article |
| id | doaj.art-6730f9f988a542a08e9e9f78be7aa84c |
| institution | Directory Open Access Journal |
| issn | 1806-907X |
| language | English |
| last_indexed | 2024-12-18T02:32:50Z |
| publishDate | 2018-11-01 |
| publisher | Sociedade Brasileira de Anestesiologia |
| record_format | Article |
| series | Revista Brasileira de Anestesiologia |
| spelling | doaj.art-6730f9f988a542a08e9e9f78be7aa84c2022-12-21T21:23:50ZengSociedade Brasileira de AnestesiologiaRevista Brasileira de Anestesiologia1806-907X2018-11-0168664564910.1016/j.bjane.2018.01.016Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case reportJosé Carlos Rodrigues NascimentoDavid Silveira MarinhoRodrigo Dornfeld EscalanteBodiyabaduge Emmanuel M. Daya Pereira JuniorCristiane Gurgel LopesRogean Rodrigues NunesAbstract Introduction: Advanced hepatic disease may - in addition to the widely recognized hemorrhagic complications - occur with thrombotic events. We describe the case of a cirrhotic patient taking warfarin and whose coagulation management during liver transplantation was guided by thromboelastometry (ROTEM®). Case report: A 56 year-old male patient diagnosed with alcohol cirrhosis using warfarin (2.5 mg.day−1) for partial portal vein thrombosis with the International Normalized Ratio (INR) of 2.14. At the beginning of surgery, the ROTEM® parameters were all normal. In the anhepatic phase, EXTEM and INTEM remained normal, but FIBTEM showed reduction of amplitude after 10 min and maximum clot firmness. Finally, in the neohepatic phase, there was a slight alteration in the hypocoagulability of most of the parameters of the EXTEM, INTEM and FIBTEM, besides a notable correction of the Coagulation Time (CT) in HEPTEM compared to the CT of the INTEM. Therefore, the patient did not receive any transfusion of blood products during surgery and in the postoperative period, being discharged on the 8th postoperative day. Discussion: Coagulation deficit resulting from cirrhosis distorts INR as a parameter of anticoagulation adequacy and as a determinant of the need for blood transfusion. Thus, thromboelastometry can provide important information for patient management.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000600645&tlng=enThromboelastometryCoagulationWarfarinLiver transplantation |
| spellingShingle | José Carlos Rodrigues Nascimento David Silveira Marinho Rodrigo Dornfeld Escalante Bodiyabaduge Emmanuel M. Daya Pereira Junior Cristiane Gurgel Lopes Rogean Rodrigues Nunes Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report Revista Brasileira de Anestesiologia Thromboelastometry Coagulation Warfarin Liver transplantation |
| title | Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report |
| title_full | Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report |
| title_fullStr | Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report |
| title_full_unstemmed | Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report |
| title_short | Monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin - case report |
| title_sort | monitoring of coagulation by intraoperative thromboelastometry of liver transplantation in a patient using warfarin case report |
| topic | Thromboelastometry Coagulation Warfarin Liver transplantation |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000600645&tlng=en |
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