RT Book, Section
A1 Görlinger, Klaus
A1 Mohinder Singh, Preet
A1 Alvarez, Adrian
A2 Molmenti, Ernesto Pompeo
A2 Santibañes, Martin de
A2 Santibañes, Eduardo de
SR Print(0)
ID 1180112602
T1 Thromboelastometry-guided Bleeding Management in Liver Transplantation
T2 Liver Transplantation: Operative Techniques and Medical Management
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260462517
LK accesssurgery.mhmedical.com/content.aspx?aid=1180112602
RD 2024/04/20
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.