Haemostatic management for aortic valve replacement in a patient with advanced liver disease

Table 1 Perioperative laboratory values and heparinase thromboelastography results

	Ref. ranges	Pre-operative	Pre-CPB	Rewarming Haemostatic intervention: FFP 15 mg/kg	Immediately post separation from CPB Haemostatic intervention: Protamine 500 mg; DDAVP 0.3 mg/kg; Concentrated fibrinogen 4 g;Platelets 2 pooled doses; 2 units packed RBC	15 min post separation from CPB Haemostatic intervention: Prothrombine × 1000 IU; then continuous infusion at 100 IU /h	30-min post separation from CPB Haemostatic intervention: Nil	Arrival intensive care unit
R (min)	4-8	6.4	5.0	6.7	6.9	28.9	7.8	6.7
K (min)	0-4	2.0	1.8	1.8	1.8	4.9	1.5	1.6
Angle (deg)	47-74	62.7	63.5	65.6	65.2	49.6	68.5	65.5
MA (mm)	54-72	53.7	61.9	61.3	57.6	71.8	69.0	70.1
LY30 (%)	0-8	0.7	0.3	0.0	0.0	1.4	0.0	0.0
INR	-	1.3	1.2	1.4	1.7	1.5	1.4	1.4
PT	11-15 s	13 s	14 s	15 s	19 h	17 h	16 h	16 h
APPT	22-38 s	36 s	39 h	> 200 h	49 h	50 h	45 h	38 s
Fib clauss	2.0-4.0 g/L		2.3 g/L	1.3 L	2.6 g/L	2.0 g/L	1.6 L	1.8 g/L
D-dimer	< 0.23 mg/L	1.05 h	Not measured	0.94 h		1.15 mg/L	Not measured	Not measured
Hb	130-180/L	90 L	83 L	73 L	55 L	85 L	Not measured	71 L
WBC	4.0-11.0 × 109	3.9 L	4.2 × 109	10.8 × 109	8.2 × 109	11.7 h	Not measured	9.4 × 109
Platelets	150-400 × 109	76 L	64 L	57 L	140 L	120 L	Not measured	73 L

The thromboelastography was performed after each of haemostatic interventions described. CPB: Cardiopulmonary bypass; FFP: Fresh frozen plasma; DDAVP: Desmopressin acetate; INR: International normalised ratio; PT: Prothrombin time; APPT: Activated partial prothrombin time; WBC: White blood cells; RBC: Red blood cells; MA: Maximum amplitude; K: Clot formation time; R: Reaction time.