Perioperative thrombotic complications in liver transplantation

作     者：Paolo Feltracco Stefania Barbieri Umberto Cillo Giacomo Zanus Marco Senzolo Carlo Ori 

作者机构：Department of MedicineUO Anaesthesia and Intensive CarePadua University Hospital Hepatobiliary Surgery and Liver Transplant UnitDepartment of SurgeryOncology and GastroenterologyUniversity Hospital of Padua Multivisceral Transplant UnitDepartment of SurgeryOncology and GastroenterologyUniversity Hospital of Padua 

出 版 物：《世界胃肠病学杂志：英文版》 (世界胃肠病学杂志)

年 卷 期：2015年第21卷第26期

页      面：8004-8013页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Vascular complications Thromboembolicphenomena Liver transplantation Hepatic arteryocclusion Postoperative complications Pulmonaryemboli 

摘      要：Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft *** during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the *** initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet *** involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative *** rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after *** of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high ***,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk *** risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important *** this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical ***,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.