ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion

Muntadhar Al Moosawi; Jacqueline Trudeau; Tyler Smith; Alexandre Lefebvre; Andrew W Shih

doi:10.1016/j.transci.2021.103125

ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion

Transfus Apher Sci. 2021 Jun;60(3):103125. doi: 10.1016/j.transci.2021.103125. Epub 2021 Mar 23.

Authors

Muntadhar Al Moosawi¹, Jacqueline Trudeau², Tyler Smith³, Alexandre Lefebvre⁴, Andrew W Shih⁵

Affiliations

¹ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
² Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.
⁵ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: andrew.shih@medportal.ca.

PMID: 33775554
DOI: 10.1016/j.transci.2021.103125

Abstract

Background: INR is traditionally used as a marker of clinical coagulopathy, but is suboptimal in liver disease patients due to rebalanced hemostasis and its ineffectiveness to predict bleeding. Rotational thromboelastometry (ROTEM) testing evaluates whole blood hemostasis, which may provide more accurate assessments with the EXTEM CT parameter than INR. Thus, in end-stage liver disease (ESLD) patients, we hypothesized that elevated INRs are associated with normal EXTEM CT values.

Methods: A retrospective study assessing adult (>18) patients with ESLD and elevated INRs undergoing liver transplantation, was performed to assess correlations between INR and EXTEM CT. This included patients post-ROTEM implementation where all had pre-operative ROTEM testing; and patients up to one year pre-ROTEM implementation to compare transfusion utilization. Data abstracted also included patient demographics, coagulation testing results, liver disease etiology, and MELD score.

Results: The study included 138 patients in the post-ROTEM group and 59 patients in the pre-ROTEM group. Normal EXTEM CT was observed in 95.3 % and 93 % of patients with INR of 1.3-1.8 and up to 3 respectively. There was no correlation between INR of 1.3-1.8 and EXTEM CT (⍴ = 0.239), and only moderate correlation was observed with higher INRs (⍴ = 0.617 with INRs >1.8). ROTEM-guided transfusion in liver transplant surgeries was associated with reduced plasma transfusion (OR 0.27, 95 % CI 0.12-0.58, p = 0.001) after adjusting for red cell utilization and coagulation testing.

Conclusion: Our study suggests ROTEM may be advantageous for evaluating coagulopathy in patients with liver disease and ROTEM-guided transfusion reduces plasma transfusion.

Keywords: Fresh frozen plasma; Liver disease; Plasma; Rotational thromboelastography; Therapeutics.

MeSH terms

Aged
Blood Component Transfusion / methods*
Female
Humans
Liver Transplantation / methods*
Male
Middle Aged
Retrospective Studies
Thrombelastography / methods*