Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure
| العنوان: | Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure |
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| المؤلفون: | Carlos O. Esquivel, Clark A. Bonham, Amy Gallo, Angela Lee, Aleah L. Brubaker, Rebecca B. McKenzie, Daniel J Stoltz, Julianne M. Mendoza |
| المصدر: | Clinical Transplantation. 34 |
| بيانات النشر: | Wiley, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Reoperation, Transplantation, business.industry, Incidence (epidemiology), Liver failure, Renal function, Perioperative, Liver Failure, Acute, 030230 surgery, medicine.disease, Graft function, Liver Transplantation, 03 medical and health sciences, 0302 clinical medicine, Cryoprecipitate, Anesthesia, Coagulopathy, Humans, Medicine, Blood Transfusion, 030211 gastroenterology & hepatology, International Normalized Ratio, Child, business |
| الوصف: | Introduction Transfusion protocols are not well-studied for pediatric patients with acute liver failure (ALF). This study evaluates the utility of an international normalized ratio (INR)-based transfusion threshold for these patients. Methods Forty-four ALF pediatric patients from 2009 to 2018 were reviewed and divided into two groups: (a) a threshold group including patients between 2009 and 2015 who were transfused for an INR above 3.0, per institutional policy (n = 30), and (b) a post-threshold group including patients after 2015 through 2018 who were transfused based on clinical judgment (n = 14). Preoperative INRs, preoperative transfusions, intraoperative transfusions, early reoperation, renal function, graft function and deaths were compared. Results Liver failure severity was similar between threshold and post-threshold groups. Threshold patients had a lower average INR prior to transplantation, 2.8 (range 1.8-3.8) vs 4.4 (range 2.1-9.0), respectively (P = .01). Twenty-six threshold patients (87%) received preoperative FFP compared with seven post-threshold patients (50%, P = .0088). Two threshold patients (7%) received preoperative cryoprecipitate compared with five post-threshold patients (36%, P = .014). The incidence of pre-transplant bleeding, operative transfusions, and 1-year patient and graft survival did not differ significantly. Conclusion Clinical judgment vs an INR-based threshold for transfusions did not increase perioperative complications in children with ALF. |
| تدمد: | 1399-0012 0902-0063 |
| DOI: | 10.1111/ctr.13819 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ac6fcbcd4a269630e259ec8c9c8e2ab9 https://doi.org/10.1111/ctr.13819 |
| Rights: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....ac6fcbcd4a269630e259ec8c9c8e2ab9 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 13990012 09020063 |
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| DOI: | 10.1111/ctr.13819 |