Anesthesia Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Donation and Transplantation Coordination Unit, Hospital Clinic de Barcelona, Barcelona, Spain.
Transfusion. 2021 Oct;61(10):3008-3016. doi: 10.1111/trf.16607. Epub 2021 Aug 6.
Antivitamin K agent (AVK) reversal in patients with cirrhosis awaiting liver transplantation (LT) is not defined in guidelines. We investigated the effect of reversion with prothrombin complex concentrate (PCC) on intraoperative transfusion, bleeding, and safety in LT patients on AVK.
In 511 patients undergoing LT, we identified 25 patients treated with AVK (AVK group) and 13 patients with incidental portal vein thrombosis (PVT) without AVK (incidental PVT group). Fifty patients who underwent LT without PVT or AVK matched by age, model for end stage of liver disease (MELD), body mass index (BMI), and cirrhosis etiology were selected as the control group.
There were no significant differences between the three groups in intraoperative blood loss, transfusion, and postoperative bleeding. In the AVK group, there were no differences between patients who received PCC and those who did not in intraoperative blood loss, red blood cells, fibrinogen, and platelet transfusion, or postoperative bleeding. PCC use had no effect on RBC transfusion in patients who had international normalized ratio or clotting time above versus below median values of the two parameters at baseline (2.3 and 103 s, respectively). No thrombotic events were detected in patients who received PCC.
These data suggest that systematic administration of PCC to revert AVK prior to LT should be reconsidered.
指南中并未明确规定肝硬化患者在等待肝移植（LT）期间使用抗维生素 K 药物（AVK）的逆转方案。我们研究了在接受 AVK 治疗的 LT 患者中使用凝血酶原复合物浓缩物（PCC）逆转对术中输血、出血和安全性的影响。
在 511 例接受 LT 的患者中，我们确定了 25 例接受 AVK 治疗的患者（AVK 组）和 13 例无 AVK 的偶然门静脉血栓形成（PVT）患者（偶然 PVT 组）。选择了 50 例无 PVT 或 AVK 且年龄、终末期肝病模型（MELD）评分、体重指数（BMI）和肝硬化病因相匹配的 LT 患者作为对照组。
三组患者术中出血量、输血和术后出血无显著差异。在 AVK 组中，接受 PCC 和未接受 PCC 的患者在术中出血量、红细胞、纤维蛋白原和血小板输血或术后出血方面无差异。在基线时两个参数的国际标准化比值或凝血时间高于或低于中位数的患者中，PCC 的使用对 RBC 输血没有影响（分别为 2.3 和 103 秒）。接受 PCC 的患者均未发生血栓事件。
这些数据表明，在 LT 前系统给予 PCC 逆转 AVK 应重新考虑。
