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Anesth Analg 2005;101:1608-1612
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000184256.28981.2B

CARDIOVASCULAR ANESTHESIA

Four Cases of Cardiopulmonary Thromboembolism During Liver Transplantation Without the Use of Antifibrinolytic Drugs

Adam B. Lerner, MD, Eswar Sundar, MD, Feroze Mahmood, MD, Todd Sarge, MD, Douglas W. Hanto, MD, PhD, and Peter J. Panzica, MD

Departments of Anesthesiology and Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Address correspondence and reprint requests to Adam B. Lerner, MD, BIDMC Department of Anesthesia, West Campus, CC 540, 1 Deaconess Rd., Boston, MA 02215. Address e-mail to alerner{at}bidmc.harvard.edu.

Orthotopic liver transplantation (OLT) is one of the most demanding surgical procedures performed. Intraoperative bleeding can be substantial and related to both surgical and nonsurgical causes. A less common but previously reported phenomenon is intraoperative cardiopulmonary thromboembolism precipitating major patient morbidity and mortality. In this paper, we present four cases of intraoperative thromboembolism during OLT. These cases were performed without the concomitant use of antifibrinolytic drugs. We performed a review and analysis of previously reported cases of intraoperative thromboembolism during OLT. Possible causes of thromboembolism, clinical management, use of thromboelastography, and the role of antifibrinolytic drugs are discussed.




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Fatal right ventricular failure with intracardiac thrombus formation during liver transplantation not apparent on postmortem examination.
Anesth. Analg., August 1, 2006; 103(2): 506 - 506.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.