[Coagulation management during liver transplantation].

In the course of liver transplantation many patients develop coagulation and bleeding disorders. On the other hand, some patients suffer thromboembolic events in the perioperative period with sometimes fatal outcome. For this reason, in 1999 we changed our coagulation management for liver transplantation and abolished the routine prophylaxis with antifibrinolytic drugs. In this context we implemented the ROTEM system (Pentapharm GmbH, Munich) in our perioperative point-of-care coagulation management. From 2000 to 2005, we analysed more than 18,000 ROTEM measurements in the context of 642 liver transplantations. Prophylactic administration of antifibrinolytic drugs was only done in patients with fulminant liver failure or if MCF in ExTEM<or=35 mm at the beginning of surgery. In the other patients hyperfibrinolysis was detected in 60% during the operation. However, therapy with an antifibrinolytic drug only was necessary in 40% of the patients. Our experience is summarised in an algorithm for ROTEM-based perioperative coagulation management for liver transplantation.