OLT and coagulation
Research type
Research Study
Full title
Alterations in coagulation profile following orthotopic liver transplantation
IRAS ID
231867
Contact name
Clare Melikian
Contact email
Sponsor organisation
Royal Free Hospital NHS Trust
Duration of Study in the UK
3 years, 0 months, 2 days
Research summary
The liver is an essential site for the production of many blood clotting proteins and liver disease is often associated with abnormalities of blood coagulation tests. It has previously been thought that the rise in specific clotting tests seen in more advanced liver disease indicates an increased risk of bleeding. In recent years, new research into coagulation indicates that despite abnormal laboratory tests, many patients with liver disease actually have a relatively normal ability to clot their blood, or even a predisposition to develop clots.
Today, it is more likely that patients undergoing liver transplantation (LT) will not require a blood transfusion. This is in part due to the way coagulation is monitored intraoperatively bedside viscoelastic tests (VET), designed to measure how blood is clotting globally, rather than using standard laboratory based tests. VETs have shown that despite conventional tests indicating poor blood clotting, many patients actually have normal clotting in LT, and in some cases accelerated clotting. This has changed the way patients are managed in the operating theatre, with many avoiding unnecessary blood transfusion to correct abnormalities seen in conventional coagulation tests.
The majority of patients will have conventional coagulation tests that indicate poor blood clotting for the first few days after LT. This can lead to transfusion of blood products to correct abnormalities in these tests, even though the patient is not actually at an increased bleeding risk, or lead to a delay in thrombosis prevention with anticoagulants, because of the perceived risk of bleeding.
Our proposed observational study will monitor postoperative coagulation using both VET and additional specific haematological clotting assays. We will compare the coagulation picture suggested by these tests to conventional coagulation tests. This study could substantially change the way we manage our patients postoperatively, and lead to improved liver graft and patient outcomes.
REC name
London - Central Research Ethics Committee
REC reference
17/LO/1776
Date of REC Opinion
3 Nov 2017
REC opinion
Favourable Opinion