Effects of ascorbic acid on coagulation during living donor liver transplantation in adults

Background: Prompt correction of hemostatic and thrombotic derangements during liver transplantation can play a key role in preventing excessive blood transfusion or thrombotic complications. It is well known that reactive oxygen species can affect coagulant and anticoagulant systems. Therefore, we investigated whether ascorbic acid (AA), one of potent antioxidant agents, can improve the coagulation during living donor liver transplantation (LDLT). Methods: Thirty three adult patients undergoing LDLT were enrolled in this study. The blood samples of these patients were collected at 90 minutes after the beginning of operation and at 150 and 300 minutes after reperfusion. At each time period, blood samples were categorized into hypocoagulation, normal, and hypercoagulation. Within each category, the samples were further divided into three groups: whole blood (WB) (0.36 ml of native WB), AA (0.33 ml of native WB mixed with 0.03 ml of AA solution), and normal saline (NS) groups (0.33 ml of n ative WB mixed with 0.03 ml of NS), and these samples were analyzed using thromboelastogram (TEG). We compared the parameters of TEG (γ time, K time, α angle, maximum amplitude (MA), and LY60) in each coagulation status. Results: AA did not significantly affect TEG parameters in hypocoagulation or normal coagulation during LDLT. However, AA significantly decreased γ time, α angle and MA at 150 minutes, and, K time and α angle at 300 minutes after reperfusion in the blood samples of hypercoagulation category. Conclusions: We may conclude that ascorbic acid inhibits hypercoagulation after reperfusion period during living donor liver transplantation. (Korean J Anesthesiol 2008; 55: 441∼5)