A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation

Alexander C. Schulick, Hunter B. Moore, Carson B. Walker, Hillary Yaffe, James J. Pomposelli, Fareed Azam, Michael Wachs, Thomas Bak, Peter Kennealey, Kendra Conzen, Megan Adams, Thomas Pshak, Rashikh Choudhury, Michael P. Chapman, Elizabeth A. Pomfret, Trevor L. Nydam

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: 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. Methods: 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. Result: 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 Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1379-1386
Number of pages8
JournalAmerican Journal of Surgery
Volume220
Issue number6
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Clinical coagulopathy
  • Coagulopathy score
  • Hemostatic resuscitation
  • Liver transplantation
  • Thrombelastography

ASJC Scopus subject areas

  • Surgery

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