Blasi A, Sabate A, Beltran J, Costa M, Reyes R, Torres F
Department of Anesthesia, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain.
Department of Anesthesia, Hospital Universitari Bellvitge Barcelona, IDIBELL, L'Hospitalet de Llobregat, Spain.
Vox Sang. 2017 Nov;112(8):788-795. doi: 10.1111/vox.12598. Epub 2017 Oct 8.
Thromboelastometry may reduce red blood cell (RBC) transfusion in liver transplantation (LT). Fibrinogen concentration is a primary determinant of FIBTEM maximum clot firmness (MCF), but several factors could affect the correlation between FIBTEM MCF and fibrinogen values. We aimed to investigate (1) the concordance between fibrinogen level and FIBTEM MCF and (2) the association of fibrinogen level and FIBTEM MCF with RBC transfusion during LT.
A post hoc analysis of data from a randomized, multicentre, double-blind, saline/fibrinogen trial was used (NCT01539057). A total of 86 adult patients were included.
The Lin concordance coefficient (LCC) between FIBTEM MCF and fibrinogen levels with the model formula 1·3679 + 0·05414* FIBTEM MCF was poor overall (LLC [95% CI]: 0·387 [0·340 to 0·432]) and moderate for the preperfusion period (LLC [95% CI]: 0·789 [0·747 to 0·824]), but very poor for the postreperfusion period (LLC [95% CI] 0·170 [0·105 to 0·233]). The model assessed for RBC transfusion for FIBTEM MCF showed an area under the curve of 0·788 [0·745-0·832]. Patients with FIBTEM MCF values <8 mm had a significantly higher likelihood of receiving RBC than patients with higher values. (OR [95% CI]: 2·08 [1·30-3·33], P = 0·002). FIBTEM MCF values over 10 mm do not appear to reduce the likelihood of RBC transfusion.
FIBTEM MCF is not a good indicator of plasma fibrinogen values after graft reperfusion. FIBTEM MCF >8 mm during the LT procedure is associated with less RBC transfusion. FIBTEM MCF values over 10 mm could lead to unnecessary fibrinogen administration.
血栓弹力图检查可能会减少肝移植（LT）中红细胞（RBC）的输注。纤维蛋白原浓度是FIBTEM最大血凝块硬度（MCF）的主要决定因素，但有几个因素可能会影响FIBTEM MCF与纤维蛋白原值之间的相关性。我们旨在研究（1）纤维蛋白原水平与FIBTEM MCF之间的一致性，以及（2）LT期间纤维蛋白原水平和FIBTEM MCF与RBC输注之间的关联。
对一项随机、多中心、双盲、生理盐水/纤维蛋白原试验的数据进行事后分析（NCT01539057）。共纳入86例成年患者。
FIBTEM MCF与纤维蛋白原水平之间的线性一致性系数（LCC），采用模型公式1·3679 + 0·05414 * FIBTEM MCF，总体较差（LCC [95% CI]：0·387 [0·340至0·432]），在灌注前期为中等（LCC [95% CI]：0·789 [0·747至0·824]），但在再灌注后期非常差（LCC [95% CI] 0·170 [0·105至0·233]）。针对FIBTEM MCF评估的RBC输注模型的曲线下面积为0·788 [0·745 - 0·832]。FIBTEM MCF值<8 mm的患者接受RBC的可能性显著高于值较高的患者。（OR [95% CI]：2·08 [1·30 - 3·33]，P = 0·002）。FIBTEM MCF值超过10 mm似乎并未降低RBC输注的可能性。
FIBTEM MCF不是移植再灌注后血浆纤维蛋白原值的良好指标。LT手术期间FIBTEM MCF >8 mm与较少的RBC输注相关。FIBTEM MCF值超过10 mm可能会导致不必要的纤维蛋白原给药。
