A point-of-care bleeding management protocol based on global viscoelastic test (thromboelastometry) can change the amount of blood products used during orthotopic liver transplant.
Patients with liver disease frequently acquire a complex disorder of hemostasis secondary to their disease. The fundamental key to the management of coagulopathy of cirrhotic patient is the knowledge that hepatic dysfunction results in impairment of both pro-hemostatic factors as anti-hemostatic factors in a disproportionate manner which can lead to a clinical picture of both bleeding and thrombosis. Routine tests of coagulation as prothrombin time (PT, INR) and activated partial thromboplastin time (APTT) although prolonged in cirrhotic patients cannot predict bleeding. Global viscoelastic test of whole blood (TEG / ROTEM) produce a dynamic composite image of the entire coagulation process and have the potential to provide clinically relevant information in patients with liver disease allowing rational use of blood products during liver transplantation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Group of cirrhotic bleeding patients that are treated with a bed side, point of care protocol based on thromboelastometry to guide transfusion and manage coagulopathy
Hospital Israelita Albert Einstein
São Paulo, São Paulo, Brazil
ACTIVE_NOT_RECRUITINGHospital Israelita Albert Einstein
São Paulo, São Paulo, Brazil
RECRUITINGUnits of packed red blood cells (PRBCs)
A prospective cohort study based on a point-of care protocol to monitor and manage the coagulopathy based on rotational thromboelastometry (ROTEM) in liver transplant with a historical control. Fifty patients will be managed by ROTEM protocol and will be compared with an equal number of historical controls treated according to the traditional protocol based on clinical and laboratory tests. The aim of this prospective study is to show a reduction in 20% of PRBCs transfusion during liver transplant.
Time frame: intraoperative
mortality
All patients in interventional group will be followed for a period of 30 days.
Time frame: 30 days
Sepsis
Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection. All patients in interventional group will be followed for a period of 30 days.
Time frame: During intensive care unit
Acute respiratory distress syndrome
A chest X-ray will be done in all patients and will be followed for a period of 30 days. A chest X-ray can reveal which parts of your lungs have fluid in them
Time frame: During intensive care unit
Mechanical ventilation
All patients in interventional group will be followed for a period of 30 days and will be noted the number of days under mechanical ventilation.
Time frame: During intensive care unit
Intensive care unit
Length of intensive care unit stay
Time frame: up to 30 days
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