Administration of Dalteparin Based on the Activated Clotting Time for Prophylaxis of Hepatic Vessel Thrombosis in Living Donor Liver Transplantation

• Published in: Transplantation proceedings Vol. 41; no. 9; pp. 3784 - 3790
• Main Authors: Uchikawa, Y, Ikegami, T, Masuda, Y, Ohno, Y, Mita, A, Urata, K, Nakazawa, Y, Terada, M, Miyagawa, S
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2009; Elsevier
• Subjects: Adult; Antithrombin III - therapeutic use; Biological and medical sciences; Blood Coagulation - drug effects; Blood Component Transfusion; Dalteparin - therapeutic use; Female; Fibrinolytic Agents - therapeutic use; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heparin - therapeutic use; Humans; Liver Circulation - drug effects; Liver Circulation - physiology; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Partial Thromboplastin Time; Plasma; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thrombosis - prevention & control; Tissue, organ and graft immunology; Whole Blood Coagulation Time; Digestive system; Clotting time; Living donor; Liver; Cardiovascular disease; Low molecular weight heparin; Anticoagulant; Homotransplantation; Thrombosis; Dalteparin sodium; Vascular disease; Medicine; Prevention; Treatment; Surgery; Blood vessel; Graft; Circulatory system; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.04.011

Abstract Beginning in 2004, dalteparin doses based on activated clotting time (ACT) were administered for hepatic vessel thrombosis prophylaxis in living donor liver transplantation (LDLT). We verified the feasibility of this new therapy by comparing it with the previous one. From 1993 through 2008, 42 metabolic liver patients who underwent LDLT were divided into two groups. Group A (1993–2003, n = 32) was administered a fixed dalteparin dose and a large amount of fresh frozen plasma (FFP); Group B (2004–2008, n = 10) was administered an appropriate dosage of dalteparin to maintain the ACT levels from 140 to 150 seconds and a small amount of FFP. Group B was administered a lesser amount of FFP and more dalteparin. This resulted in longer activated partial thromboplastin time, lower fibrinogen degradation products D-dimer, and lower aspartate aminotransferase levels compared to group A; all differences were significant. Group B showed neither thrombotic nor hemorrhagic complications. Anticoagulation therapy comprising adjustment of the dalteparin dose based on ACT reduces thrombotic complications without increasing hemorrhagic complications. ACT measurement is a simple, reliable method for bedside monitoring of dalteparin anticoagulant effects for LDLT.