Yassen Khaled Ahmed, Shahwar Dur I, Alrasasi Aqeel Qasem, Aldandan Feras, Alali Danah Sami, Almuslem Maryam Yousef, Hassanein Nouran, Khan Imtiyaz, Görlinger Klaus
Anaesthesia Unit, Surgery Department, College of Medicine, King Faisal University, P.O. Box 400, AlAhsa 31982, Saudi Arabia.
Alumini, College of Medicine, King Faisal University, P.O. Box 400, AlAhsa 31982, Saudi Arabia.
J Clin Med. 2024 Oct 21;13(20):6279. doi: 10.3390/jcm13206279.
Liver transplantation is a complex surgical procedure in which various forms of coagulation dysfunction can occur, including perioperative hypercoagulability. The hemostasis balance in liver graft recipients with end-stage liver disease can shift to thrombosis or haemorrhage, depending on the associated risk factors and clinical conditions. Hypercoagulability can result in serious complications such as thromboembolism, which can affect the vessels of the newly transplanted liver graft. Standard coagulation tests (SCTs), such as prothrombin time and activated partial thromboplastin time (aPTT), have a poor ability to diagnose and monitor an early stage of hypercoagulability. Recent studies demonstrated that viscoelastic hemostatic elastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are promising alternative tools for diagnosing hypercoagulability disorders. VETs measure clotting and clot formation time, clot strength (maximum clot firmness), fibrin and platelet contribution to clot firmness, and fibrinolysis, which makes them more sensitive in identifying liver graft recipients at risk for thrombosis as compared with SCTs. However, developing evidence-based guidelines for the prophylaxis and treatment of hypercoagulability based on VET results is still needed.
肝移植是一种复杂的外科手术，在此过程中可能会出现各种形式的凝血功能障碍，包括围手术期高凝状态。终末期肝病肝移植受者的止血平衡可能会转向血栓形成或出血，这取决于相关的危险因素和临床状况。高凝状态可导致严重并发症，如血栓栓塞，这可能会影响新移植肝移植物的血管。标准凝血试验（SCTs），如凝血酶原时间和活化部分凝血活酶时间（aPTT），对高凝状态早期的诊断和监测能力较差。最近的研究表明，黏弹性止血弹性试验（VETs），如旋转血栓弹力图（ROTEM）和血栓弹力图（TEG），是诊断高凝性疾病的有前景的替代工具。VETs可测量凝血和凝块形成时间、凝块强度（最大凝块硬度）、纤维蛋白和血小板对凝块硬度的贡献以及纤维蛋白溶解，这使得它们在识别有血栓形成风险的肝移植受者方面比SCTs更敏感。然而，仍需要根据VET结果制定基于证据的高凝状态预防和治疗指南。
