الفهرس 
Aim of the workOnly 14 pages are availabe for public view
 |  | from | 77 |  |  |
| | | from | 77 | | |
Abstract
In this essay we discussed the perioperative coagulopathy during liver transplantation including monitoring of coagulation and the perioperative management of coagulopathy.
The concept of hemostasis system has been altered dramatically within the past few years. The classical model of the clotting cascade with an extrinsic and an intrinsic system has been replaced by a cell based model of coagulation. This model reflects much better the close interactions between cellular and plasmatic factors in hemostasis than the classical model.
The liver is the primary site of synthesis of most of the clotting factors and the proteins involved in the fibrinolytic system. These include all the vitamin K-dependent coagulation proteins (factors II, VII, IX, X, protein C, protein S and protein Z), as well as factor V, XIII, fibrinogen, antithrombin, α2 plasmin inhibitor and plasminogen.
End stage liver disease (ESLD) results in impaired synthesis of clotting factors, excessive fibrinolysis, disseminated intravascular coagulation (DIC), thrombocytopenia, and platelet dysfunction that results in severe hemostatic defects.
In most patients with acute or chronic liver failure, extensive changes in all pathways contributing to hemostasis are found. These hemostatic alterations concern both pro- and antihemostatic pathways, and therefore the net result of the hemostatic dysbalance is unclear.
Liver transplantation (LT) is replacement of a damaged liver with a healthy liver allograft. It is now widely acknowledged as the only treatment for end-stage liver disease. It extends patients’ lives and improves their quality of life.