TY - CHAP M1 - Book, Section TI - Thromboelastometry-guided Bleeding Management in Liver Transplantation A1 - Görlinger, Klaus A1 - Mohinder Singh, Preet A1 - Alvarez, Adrian A2 - Molmenti, Ernesto Pompeo A2 - Santibañes, Martin de A2 - Santibañes, Eduardo de PY - 2021 T2 - Liver Transplantation: Operative Techniques and Medical Management AB - Hemostasis in cirrhosis is rebalanced on a lower level that can rapidly devolve to bleeding and thrombosis (Fig. 57-1).1–4The hemostatic changes are better reflected by viscoelastic testing rather than standard coagulation laboratory tests (SCLTs) such as PT/INR (international normalized ratio), aPTT, and platelet count.5–9Clear evidence for the clinical utility of TEG/ROTEM protocols exist, as they prevent both over-transfusion and undertransfusion.10–20The traditional TEG works with a free-pending pin in a rotating cuvette. The clotting process is detected via a torsion wire. Due to the free suspension of the pin, the TEG is extremely sensitive to vibrations and mechanical shocks. This flaw is overcome in the ROTEM system by using a rotating pin fixed on a steel axis, which is stabilized by a unique ball bearing and a precise optical detection method. Clinically relevant parameters of ROTEM and TEG are shown in Fig. 57-2. Characteristic ROTEM traces in various coagulation conditions are shown in Fig. 57-3. Various activators used in different ROTEM assays and their implications are shown in Table 57-1. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1180112602 ER -