A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation.
A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation.
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DOI：
10.1016/j.amjsurg.2020.07.034
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发表时间：
2020-12
影响因子：
3
通讯作者：
Nydam TL
中科院分区：
文献类型：
--
作者：
Schulick AC;Moore HB;Walker CB;Yaffe H;Pomposelli JJ;Azam F;Wachs M;Bak T;Kennealey P;Conzen K;Adams M;Pshak T;Choudhury R;Chapman MP;Pomfret EA;Nydam TL
美国国立卫生研究院（NIH）为创伤患者设计了临床凝血功能评分，但在移植手术中没有这样的临床评分。我们假设这种凝血功能障碍评分可以有效地识别肝移植期间实验室定义的凝血功能障碍，并与血液制品的使用相关。进行teg测试，并在术中5个时间点由外科医生分配凝血功能评分（1分，正常出血- 5分，弥漫性凝血功能出血）。病例期间使用的血液制品在不同时间点之间进行了记录。进行统计分析以确定凝血功能障碍评分、teg检测异常和血液制品使用之间的相关性。输血很少与凝血功能障碍的适当TEG测量相关。凝血功能评分与病例中多次输注及多点teg检测的凝血功能有显著相关性。如果粘弹性测试和标准化的临床凝血功能评分结合使用，就有可能优化输血，并使手术和麻醉团队之间关于临床明显凝血功能的沟通标准化。
An NIH clinical coagulopathy score has been devised for trauma patients, but no such clinical score exists in transplantation surgery. We hypothesize that that this coagulopathy score can effectively identify laboratory defined coagulopathy during liver transplantation and correlates to blood product utilization. TEGs were performed and coagulopathy scores (1, normal bleeding – 5, diffuse coagulopathic bleeding) were assigned by the surgeons at 5 intra-operative time points. Blood products used during the case were recorded between time points. Statistical analyses were performed to identify correlations between coagulopathy scores, TEG-detected abnormalities, and blood product utilization. Transfusions rarely correlated with the appropriate TEG measurements of coagulation dysfunction. Coagulopathy score had significant correlation to various transfusions and TEG-detected coagulopathies at multiple points during the case. High aggregate coagulopathy scores identified patients receiving more transfusions, re-operations, and longer hospital stays The combination of viscoelastic testing and a standardized clinical coagulopathy score has the potential to optimize transfusions if used in tandem as well as standardize communication between surgery and anesthesia teams about clinically evident coagulopathy.
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DOI：
10.1590/s1679-45082017md3903
发表时间：
2017-06-01
期刊：
Einstein (São Paulo)
影响因子：
--
作者：
Zamper, Raffael Pereira Cezar;Amorim, Thiago Chaves;Serpa Neto, Ary
通讯作者：
Serpa Neto, Ary
影响因子：
2.2
作者：
Lawson, Peter J.;Moore, Hunter B.;Nydam, Trevor L.
通讯作者：
Nydam, Trevor L.
影响因子：
6.2
作者：
Massicotte, Luc;Denault, Andre Y.;Roy, Andre
通讯作者：
Roy, Andre
影响因子：
1.9
作者：
Naderi, Majid;Cohan, Nader;Karimi, Mehran
通讯作者：
Karimi, Mehran
与纤维蛋白原浓缩酸盐相比，新鲜冷冻血浆的临床有效性：系统评价。
DOI：
10.1186/cc10488
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kozek-Langenecker S;Sørensen B;Hess JR;Spahn DR
通讯作者：
Spahn DR