PREDICTIVE FACTORS OF HYPERFIBRINOLYTIC ACTIVITY DURING LIVER-TRANSPLANTATION IN CIRRHOTIC-PATIENTS

Hyperfibrinolytic activity occurs frequently during liver transplantation in cirrhotic patients. in order to identify those patients at high risk for increased intraoperative blood loss before operation, we determined predictive indicators of hyperfibrinolysis. We studied 56 cirrhotic patients undergoing liver transplantation with the same anaesthetic procedure and transfusion regimen. The preoperative coagulation patterns of the 11 patients who experienced acute intraoperative hyperfibrinolytic activity were compared with those of the 45 patients who did not suffer this complication. surgery, patients with intraoperative fibrinolysis had decreased prothrombin time (PT) and euglobulin lysis time (ELT), and increased thrombin time (TT) and fibrinogen degradation products (FDP), whereas a angle and maximum amplitude (MA) were reduced on thrombelastography. Stepwise multivariate analysis disclosed three components which were significantly linked with occurrence of hyperfibrinolysis: TT, FDP and MA. Their sensitivity, specificity, positive and negative predictive values demonstrated that patients with FDP greater than or equal to 48 mg litre(-1) and MA less than or equal to 35 mm before incision had 100% probability of developing hyperfibrinolytic activity during transplantation.