**3.3. Coagulation management**

Cirrhotic patients have been regarded as having a high risk of bleeding due to standard coagulation test abnormalities caused by cirrhotic coagulopathy. Recent studies have shown that bleeding episodes are caused by vascular abnormalities and portal hypertension [48].

Antifibrinolytic agents can be used when diffuse bleeding occurs or when point of care tests show hyperfibrinolysis. In case of diffuse bleeding, the anaesthetist must correct hypothermia, acidosis, hypocalcaemia, treat hyperfibrinolysis and then administer fibrinogen

Anesthesia for Liver Transplantation http://dx.doi.org/10.5772/intechopen.75167 223

Anaesthesia for liver transplantation is one of the most difficult anaesthesias. This is due to the haemodynamic problems that can occur in the intraoperative, related both to the status of the patient (cardiomyopathy of the cirrhosis, etc.) and to the surgical moments (bleeding and

A good understanding of the pathophysiology of the cirrhotic patient is very important for best decision making. Adequate perioperative management is extremely important for a suc-

reperfusion syndrome) as well as to the blood coagulation pattern of the patient.

Fundeni Clinical Institute, University of Medicine and Pharmacy "Carol Davila",

[1] Gologorsky E, Pretto Jr EA, Fukazawa K. Coronary artery disease and its risk factors in patients presenting for liver transplantation. Journal of Clinical Anesthesia.

[2] Ripoll C, Yotti R, Bermejo J, Banares R. The heart in liver transplantation. Journal of

[3] Martinez-Palli G, Cardenas A. Preoperative cardio pulmonary assessment of the liver transplant candidate. Annals of Hepatology. 2011;**10**:421-433. https://www.hindawi.

cessful liver transplantation with a good outcome.

The authors have no conflict of interest to declare.

\*Address all correspondence to: gabidroc@gmail.com

24 mg/kgc and platelets.

**Conflict of interest**

**Author details**

Bucharest, Romania

2013;**25**:618-623

Hepatology. 2011;**54**:810-822

com/journals/ccrp/2012/539412/cta/

**References**

Gabriela Droc\* and Lavinia Jipa

**4. Conclusion**

Standard coagulation tests (prothrombin time, INR and activated partial thromboplastin time (aPTT)) reveal the deficit of procoagulant factors without showing the status of the anticoagulant factors.

In order to have an optimal view regarding cirrhotic coagulopathy, global coagulation tests (viscoelastic tests) are recommended [49].

Intraoperative blood transfusion has a negative impact on patient outcome. Intraoperative packed red cells and platelet transfusion are independent predictors of 1 year mortality [50].

There are a few measures that can decrease the need of blood transfusion:


The most important coagulation problems that can appear during the three transplant phases are specific for each phase:


Hyperfibrinolysis can often appear during liver transplantation, but is self-limited as long as the liver graft is viable.

Antifibrinolytic agents can be used when diffuse bleeding occurs or when point of care tests show hyperfibrinolysis. In case of diffuse bleeding, the anaesthetist must correct hypothermia, acidosis, hypocalcaemia, treat hyperfibrinolysis and then administer fibrinogen 24 mg/kgc and platelets.
