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Transfusion criteria for liver transplantation: Treat only if there is clinically significant bleeding[1]

Transfusion criteria for liver transplantation: Treat only if there is clinically significant bleeding[1]
  Transfusion criteria
ROTEM TEG Other
Fresh frozen plasma Prolonged ROTEM clotting time (CT) in INTEM and EXTEM Prolonged R-time  
Platelets Low ROTEM maximal clot firmness (MCF) in EXTEM with normal or high MCF in FIBTEM High TEG maximal amplitude functional fibrinogen (MAFF) and/or a low maximal amplitude (MA) <50,000/mm3
Cryoprecipitate Decreased ROTEM MCF in FIBTEM and EXTEM Low TEG MAFF and a small alpha angle  
Fibrinogen concentrates Decreased ROTEM MCF in FIBTEM and EXTEM Low TEG MAFF and a small alpha angle  
ROTEM: rotational thromboelastometry; TEG: thromboelastography; INTEM: reflecting intrinsic pathway; EXTEM: reflecting extrinsic pathway; FIBTEM: extrinsic pathway with platelet inhibitor to assess fibrinogen contribution.
Reference:
  1. Bezinover D, Dirkmann D, Findlay J, et al. Perioperative Coagulation Management in Liver Transplant Recipients. Transplantation 2018; 102:578.
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