• Antònia Dalmau, Antoni Sabaté, and Idoia Aparicio.
• Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelone, Barcelona, Spain. madalmau@bellvitgehospital.cat
• Curr Opin Organ Transplant. 2009 Jun 1;14(3):286-90.

Purpose Of ReviewThe objective of this review is to evaluate the present state of nonpharmacological measures, pharmacological measures applied to reduce bleeding and perioperative blood products management during orthotopic liver transplantation.Recent FindingsRecent studies improve the knowledge in the hemostatic response in cirrhotic patients such as thrombin generation and platelet adhesion due to elevated levels of von Willebrand factor. Restrictive fluid therapy is an important measure to avoid hemodilution and so bleeding. Prophylaxis with antifibrinolytics is being questioned for the risk of thrombosis. Correction of coagulation defects with fresh frozen plasma has not reduced blood loss, and it has been related to worse outcome. Also, platelets administration has a negative effect in the outcome.SummaryIn order to maintain hemostatic system in compensated cirrhotic patient, every effort we do to improve it must consider not to imbalance it resulting in thrombi-hemorrhagic events. Pharmacological measures must be based on their clinical evidence. Identification of high risk bleeding patients would help in developing coagulation guidelines.

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