指南中未定义等待肝移植(LT)的肝硬化患者的抗维生素K剂(AVK)逆转。我们研究了凝血酶原复合物浓缩物(PCC)的逆转对术中输血的影响,出血,AVKLT患者的安全性。
在接受LT的511名患者中,我们确定了25例接受AVK治疗的患者(AVK组)和13例无AVK的偶发性门静脉血栓(PVT)患者(偶发性PVT组).50例接受LT无PVT或AVK的患者按年龄匹配,肝病终末期模型(MELD),体重指数(BMI),选择肝硬化病因作为对照组。
三组术中出血量无明显差异,输血,术后出血。在AVK组中,接受PCC的患者和术中失血的患者之间没有差异,红细胞,纤维蛋白原,和血小板输注,或术后出血.使用PCC对基线时两个参数的国际标准化比率或凝血时间高于或低于中位数(2.3和103s,分别)。在接受PCC的患者中未检测到血栓事件。
这些数据表明,应重新考虑在LT之前对PCC进行系统管理以恢复AVK。
Antivitamin K agent (AVK) reversal in patients with cirrhosis awaiting liver transplantation (LT) is not defined in guidelines. We investigated the effect of reversion with prothrombin complex concentrate (PCC) on intraoperative transfusion, bleeding, and safety in LT patients on AVK.
In 511 patients undergoing LT, we identified 25 patients treated with AVK (AVK group) and 13 patients with incidental portal vein thrombosis (PVT) without AVK (incidental PVT group). Fifty patients who underwent LT without PVT or AVK matched by age, model for end stage of liver disease (MELD), body mass index (BMI), and cirrhosis etiology were selected as the control group.
There were no significant differences between the three groups in intraoperative blood loss, transfusion, and postoperative bleeding. In the AVK group, there were no differences between patients who received PCC and those who did not in intraoperative blood loss, red blood cells, fibrinogen, and platelet transfusion, or postoperative bleeding. PCC use had no effect on RBC transfusion in patients who had international normalized ratio or clotting time above versus below median values of the two parameters at baseline (2.3 and 103 s, respectively). No thrombotic events were detected in patients who received PCC.
These data suggest that systematic administration of PCC to revert AVK prior to LT should be reconsidered.