Coagulation abnormalities, bleeding, thrombosis, and management of patients with acute liver failure in Australia and New Zealand
Por:
Warrillow, S, Fisher, C, Tibballs, H, Bailey, M, McArthur, C, Lawson-Smith, P, Prasad, B, Anstey, M, Venkatesh, B, Dashwood, G, Walsham, J, Holt, A, Wiersema, U, Gattas, D, Zoeller, M, Alvarez, MG, Bellomo, R
Publicada:
1 may 2020
Ahead of Print:
1 nov 2019
Resumen:
Background and Aim To study the management of coagulation and hematological derangements among severe acute liver failure (ALF) patients in Australia and New Zealand liver transplant intensive care units (ICUs). Methods Analysis of key baseline characteristics, etiology, coagulation and hematological tests, use of blood products, thrombotic complications, and clinical outcomes during the first ICU week. Results We studied 62 ALF patients. The first day median peak international normalized ratio was 5.5 (inter-quartile range [IQR] 3.8-8.7), median longest activated partial thromboplastin time was 62 s (IQR 44-87), and median lowest fibrinogen was 1.1 (IQR 0.8-1.6) g/L. Fibrinogen was only measured in 85% of patients, which was less than other tests (P < 0.0001). Median initial lowest platelet count was 83 (IQR 41-122) x 10(9)/L. Overall, 58% of patients received fresh frozen plasma, 40% cryoprecipitate, 35% platelets, and 15% prothrombin complex concentrate. Patients with bleeding complications (19%) had more severe overall hypofibrinogenemia and thrombocytopenia. Thrombotic complications were less common (10% of patients), were not associated with consistent patterns of abnormal hemostasis, and were not immediately preceded by clotting factor administration and half occurred only after liver transplantation surgery. Conclusion In ALF patients admitted to dedicated Australia and New Zealand ICUs, fibrinogen was measured less frequently than other coagulation parameters but, together with platelets, appeared more relevant to bleeding risk. Blood products and procoagulant factors were administered to most patients at variable levels of hemostatic derangement, and bleeding complications were more common than thrombotic complications. This epidemiologic information and practice variability provide baseline data for the design and powering of interventional studies.
Filiaciones:
Warrillow, S:
Austin Hlth, Dept Intens Care, 145 Studley Rd, Heidelberg, Vic 3084, Australia
Univ Melbourne, Dept Med & Surg, Melbourne, Vic, Australia
Fisher, C:
Austin Hlth, Dept Intens Care, 145 Studley Rd, Heidelberg, Vic 3084, Australia
Tibballs, H:
Austin Hlth, Dept Intens Care, 145 Studley Rd, Heidelberg, Vic 3084, Australia
Bailey, M:
Univ Melbourne, Dept Med & Surg, Melbourne, Vic, Australia
McArthur, C:
Med Res Inst New Zealand, Auckland, New Zealand
Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand
Lawson-Smith, P:
Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand
Prasad, B:
South Metropolitan Hlth Serv, Rockingham, Australia
Anstey, M:
Sir Charles Gairdner Hosp, Dept Intens Care, Perth, WA, Australia
Venkatesh, B:
Princess Alexandra Hosp, Dept Intens Care, Brisbane, Qld, Australia
Dashwood, G:
Princess Alexandra Hosp, Dept Intens Care, Brisbane, Qld, Australia
Walsham, J:
Princess Alexandra Hosp, Dept Intens Care, Brisbane, Qld, Australia
Holt, A:
Flinders Med Ctr, Dept Intens Care, Adelaide, SA, Australia
Wiersema, U:
Flinders Med Ctr, Dept Intens Care, Adelaide, SA, Australia
Gattas, D:
Royal Prince Alfred Hosp, Dept Intens Care, Sydney, NSW, Australia
Zoeller, M:
Royal Prince Alfred Hosp, Dept Intens Care, Sydney, NSW, Australia
Alvarez, MG:
Univ Barcelona, Hosp Santa Creu & St Pau, Dept Anesthesiol & Pain Med, Barcelona, Spain
Bellomo, R:
Austin Hlth, Dept Intens Care, 145 Studley Rd, Heidelberg, Vic 3084, Australia
Univ Melbourne, Dept Med & Surg, Melbourne, Vic, Australia
Royal Melbourne Hosp, Dept Intens Care, Melbourne, Vic, Australia
Austin Hosp, Data Analyt Res & Evaluat DARE Ctr, Melbourne, Vic, Australia
Univ Melbourne, Melbourne, Vic, Australia
Univ Melbourne, Ctr Integrated Crit Care, Melbourne, Vic, Australia
Green Published
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