Prothrombin complex concentrate in the reduction of blood loss during orthotopic liver transplantation: PROTON-trial
Arshad, Freeha × Ickx, Brigitte van Beem, Rachel T Polak, Wojciech Grüne, Frank Nevens, Frederik Ilmakunnas, Minna Koivusalo, Anna-Maria Isoniemi, Helena Strengers, Paul F W Groen, Henk Hendriks, Herman G D Lisman, Ton Pirenne, Jacques Porte, Robert J #
BMC Surgery vol:13 pages:22
In patients with cirrhosis, the synthesis of coagulation factors can fall short, reflected by a prolonged prothrombin time. Although anticoagulants factors are decreased as well, blood loss during orthotopic liver transplantation can still be excessive. Blood loss during orthotopic liver transplantation is currently managed by transfusion of red blood cell concentrates, platelet concentrates, fresh frozen plasma, and fibrinogen concentrate. Transfusion of these products may paradoxically result in an increased bleeding tendency due to aggravated portal hypertension. The hemostatic effect of these products may therefore be overshadowed by bleeding complications due to volume overload.In contrast to these transfusion products, prothrombin complex concentrate is a low-volume highly purified concentrate, containing the four vitamin K dependent coagulation factors. Previous studies have suggested that administration of prothrombin complex concentrate is an effective method to normalize a prolonged prothrombin time in patients with liver cirrhosis. We aim to investigate whether the pre-operative administration of prothrombin complex concentrate in patients undergoing liver transplantation for end-stage liver cirrhosis, is a safe and effective method to reduce perioperative blood loss and transfusion requirements.