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  1. Book ; Thesis: Evaluation der Sicherheit einer ROTEM™- gesteuerten Therapie mit Gerinnungsfaktoren bei Lebertransplantationen

    Walde, Caroline / Hartmann, Matthias

    2023  

    Institution Universität Duisburg-Essen
    Author's details vorgelegt von Caroline Walde, geb. Simon ; 1. Gutachter: Herr Prof. Dr. med. M. Hartmann, 2. Gutachter: Herr Priv.-Doz. Dr. med. D.P. Hoyer
    Language German
    Size 53 Seiten, Illustrationen
    Publishing place Duisburg ; Essen
    Publishing country Germany
    Document type Book ; Thesis
    Thesis / German Habilitation thesis Dissertation, Universität Duisburg-Essen, 2023
    HBZ-ID HT030608200
    Database Catalogue ZB MED Medicine, Health

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  2. Article ; Online: Safety of coagulation factor concentrates guided by ROTEM™-analyses in liver transplantation: results from 372 procedures.

    Hartmann, Matthias / Walde, Caroline / Dirkmann, Daniel / Saner, Fuat H

    BMC anesthesiology

    2019  Volume 19, Issue 1, Page(s) 97

    Abstract: Background: Most centres use fresh frozen plasma (FFP) based protocols to prevent or treat haemostatic disturbances during liver transplantation. In the present study, we used a rotational thrombelastometry (ROTEM™, TEM, Munich, Germany) guided ... ...

    Abstract Background: Most centres use fresh frozen plasma (FFP) based protocols to prevent or treat haemostatic disturbances during liver transplantation. In the present study, we used a rotational thrombelastometry (ROTEM™, TEM, Munich, Germany) guided haemostasis management with fibrinogen concentrates, prothrombin complex concentrates (PCC), platelet concentrates and tranexamic acid without FFP usage and determined the effect on 30 day mortality.
    Methods: Retrospective data analysis with 372 consecutive adult liver transplant patients performed between 2007 and 2011.
    Results: Thrombelastometry guided coagulation management resulted in a transfusion rate for fibrinogen concentrates in 50.2%, PCC in 18.8%, platelet concentrates in 21.2%, tranexamic acid in 4.5%, and red blood cell concentrates in 59.4%. 30 day mortality for the whole cohort was 14.2%. The univariate analyses indicated that nonsurvivors received significantly more fibrinogen concentrates, PCC, red blood cell concentrates, platelet concentrates, and infusion volume, and had a higher MELD score. However, association with mortality was weak as evidenced by receiver operating characteristic curve analyses. Further univariate analyses demonstrated, that up to 8 g of fibrinogen did not increase mortality compared to patients not receiving the coagulation factor. Multivariate analysis demonstrated that platelet concentrates (p = 0.0002, OR 1.87 per unit), infused volume (p = 0.0004, OR = 1.13 per litre), and MELD score (p = 0.024; OR 1.039) are independent predictors for mortality. Fibrinogen concentrates, PCC, and red blood cell concentrates were ruled out as independent risk factors.
    Conclusions: ROTEM™ guided substitution with fibrinogen concentrates and PCC does not negatively affect mortality after liver transplantation, while the well-known deleterious effect associated with platelet concentrates was confirmed.
    MeSH term(s) Adolescent ; Adult ; Aged ; Antifibrinolytic Agents/administration & dosage ; Antifibrinolytic Agents/blood ; Blood Coagulation/drug effects ; Blood Coagulation/physiology ; Blood Coagulation Factors/administration & dosage ; Blood Coagulation Factors/metabolism ; Blood Platelets/metabolism ; Child ; Female ; Fibrinogen/administration & dosage ; Fibrinogen/metabolism ; Hemostasis/drug effects ; Hemostasis/physiology ; Hemostatics/administration & dosage ; Hemostatics/blood ; Humans ; Liver Transplantation/adverse effects ; Liver Transplantation/methods ; Liver Transplantation/mortality ; Liver Transplantation/trends ; Male ; Middle Aged ; Mortality/trends ; Retrospective Studies ; Rotation ; Thrombelastography/adverse effects ; Thrombelastography/methods ; Tranexamic Acid/administration & dosage ; Tranexamic Acid/blood ; Young Adult
    Chemical Substances Antifibrinolytic Agents ; Blood Coagulation Factors ; Hemostatics ; Tranexamic Acid (6T84R30KC1) ; Fibrinogen (9001-32-5)
    Language English
    Publishing date 2019-06-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1471-2253
    ISSN (online) 1471-2253
    DOI 10.1186/s12871-019-0767-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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