During liver transplantation hypercoagulability on thromboelastography may predict fibrinolysis

Thromboelastography is widely used to monitor hemostatic status during liver transplantation. Little data exists relating successive thromboelastograms(TEGs) during the course of surgery. TEGs from 22 consecutive orthotopic liver transplantations were evaluated for fibrinolysis and related findings. Coagulation changes were grouped into episodes rather than noting single TEG results. Fibrinolysis seldom appeared abruptly or primarily, rather it was usually(24/31) immediately preceded by an episode of hypercoagulability. Conversely, hypercoagulability was usually not self limited, but rather most(24/33) episodes of hypercoagulability were immediately followed by fibrinolysis. Further study is needed to determine the extent and clinical significance of hypercoagulability and its relationship to DIG. However TEG hypercoagulability may be a useful marker for potential fibrinolysis.