Thromboelastometry provides individualized measures of clot kinetics and structure, and has played an increasingly important role in the management of coagulopathy during liver transplants and other traumatic bleeding events. Thromboelastometry for fibrin function (FIBTEM) also predicts transfusion needs during liver transplants. Researchers in Spain noted that no studies have explored higher FIBTEM values over standard care (A10 FIBTEM value of 8 mm). They hypothesized that bolus infusions of fibrinogen concentrate to reach a higher FIBTEM value (A10 FIBTEM value of 11 mm) may decrease the need for blood transfusions during liver transplants. From 2019 to 2021, 189 patients requiring liver transplants were randomized to receive bolus fibrinogen infusions to reach a target of either 11 mm (treatment arm, n=91) or 8 mm (standard care, n=85) at the start of the liver transplant. Patients requiring RBC transfusions were similar in both arms—74.7% in the treatment arm compared to 72.9% in the standard care arm (P=0.922)—as were thrombotic events and mortality. Further studies are needed to best manage coagulopathy in patients requiring liver transplantation.
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