Perioperative thromboprophylaxis in liver transplant patients  

作　　者：Lesley De Pietri Roberto Montalti Daniele Nicolini Roberto Ivan Troisi Federico Moccheggiani Marco Vivarelli 

机构地区：[1]Division of Anaesthesiology and Intensive Care Unit,Department of General Surgery,AUSL Reggio Emilia-IRCCS,Reggio Emilia 42123,Italy [2]Hepatobiliary and Abdominal Transplantation Surgery,Department of Experimental and Clinical Medicine,Polytechnic University of Marche,Ancona 60126,Italy [3]Department of General,Hepatobiliary and Liver Transplantation Surgery,Ghent University Hospital Medical School,Ghent 185 3K3 9000,Belgium

出　　处：《World Journal of Gastroenterology》2018年第27期2931-2948,共18页世界胃肠病学杂志（英文版）

摘　　要：Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation(LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications(intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors(portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ‘‘rebalanced hemostasis' ' can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors(venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT.Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation(LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications(intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors(portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ‘‘rebalanced hemostasis' ' can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors(venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT.

关 键 词：ANTICOAGULATION Liver transplantation ANTIPLATELETS THROMBOSIS Coagulation HEPARIN THROMBOELASTOGRAPHY THROMBOPROPHYLAXIS Hepatic artery THROMBOSIS Portal vein THROMBOSIS 

分 类 号：R57[医药卫生—消化系统]