{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:53:16Z","timestamp":1791643996584,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T00:00:00Z","timestamp":1746921600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>End\u2010stage liver disease induces a precarious hemostatic equilibrium, named rebalanced hemostasis. Liver transplantation additionally causes profound disturbances in the hemostatic balance. Hyperfibrinolysis poses a relevant impairment to the coagulation process during liver transplantation. During surgery, the hemostatic management is guided by viscoelastic monitoring systems. The aim of this prospective, observational study was to evaluate the incidence of hyperfibrinolysis during liver transplantation using different viscoelastic assays, namely an ecarin\u2010based test and a tissue factor\u2010based test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Blood sampling was done at five measurement time points during liver transplantation (T1 induction of general anesthesia, T2 start of anhepatic phase, T3 end of anhepatic phase, T4 10 min after reperfusion, T5 end of surgery). Viscoelastic testing included ClotPro assays EX\u2010test, FIB\u2010test, AP\u2010test, and ECA\u2010test. Hyperfibrinolysis was defined as a maximum lysis of at least 15%. Lysis detection time (LDT) served as an indicator for the velocity of lysis, marking the time point when less than 85% of the clot are extant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty transplantation surgeries were included. A total of 150 viscoelastic measurements have been performed. The ECA\u2010test detected hyperfibrinolysis significantly more often (31 [21%] vs. 22 [15%] out of 150, <jats:italic>p<\/jats:italic> = 0.039) and in a higher number of patients than the EX\u2010test. The ECA\u2010test revealed hyperfibrinolysis significantly earlier compared to the EX\u2010test (median LDT 2100\u00a0s [1500\/2900] vs. 3300\u00a0s [2400\/3800], <jats:italic>p<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates higher sensitivity of the ecarin\u2010test than the tissue\u2010factor\u2010test in monitoring hyperfibrinolysis, with more frequent and earlier detection of this coagulopathy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>German Clinical Trials Register: DRKS00032827<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70179","type":"journal-article","created":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T07:09:19Z","timestamp":1746947359000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hyperfibrinolysis Detection During Liver Transplantation Using Viscoelastometry"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7957-9822","authenticated-orcid":false,"given":"Sarah","family":"Thaler","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Zorn","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Aster","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionysios","family":"Koliogiannis","sequence":"additional","affiliation":[{"name":"Department of General\u2010, Visceral\u2010 and Transplant\u2010Surgery LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard W.","family":"Renz","sequence":"additional","affiliation":[{"name":"Department of General\u2010, Visceral\u2010 and Transplant\u2010Surgery LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Guba","sequence":"additional","affiliation":[{"name":"Department of General\u2010, Visceral\u2010 and Transplant\u2010Surgery LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8357-5552","authenticated-orcid":false,"given":"Philipp","family":"Groene","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology LMU University Hospital, LMU Munich  Munich 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