Abstract
Purpose
Patients undergoing liver transplantation may be predisposed to hypomagnesemia and present a bleeding tendency. There are evidences suggesting that magnesium is a crucial constituent of the blood coagulation cascade and has a pro-coagulant activity. The aim of this study was to investigate the effect of magnesium therapy on thromboelastography (TEG) in patients undergoing liver transplantation.
Methods
27 patients scheduled for liver transplantation were enrolled. 1.5 g of magnesium sulfate, diluted in normal saline, were infused to all patients over five minutes in the operating room, before skin incision. The TEG findings immediately before and ten minutes after the magnesium infusion were compared.
Results
The TEG findings showed general hypocoagulability before magnesium therapy. The Ktime and coagulation times (r+k) were shortened significantly from 641.6 ± 505.9 (mean ± SD) to 464.6 ± 387.7 sec and from 1664.7 ± 772.5 to 1362.2 ± 487.1 sec respectively (P < 0.05); the maximal amplitude, and TEG index showed significant increases from 38.5 ± 13.5 to 45.3 ± 12.2 mm and from-3.4 ± 2.6 to-1.9 ± 1.8 respectively after magnesium therapy (P < 0.01). R time, alpha angle and LY60 were not different after magnesium therapy.
Conclusion
Magnesium therapy significantly improved TEG findings suggestive of a general hypocoagulable state towards normal in patients about to receive liver transplantation.
Résumé
Objectif
Les patients qui subissent une transplantation hépatique peuvent être prédisposés à l’hypomagnésiémie et ont une tendance aux saignements. Il y a des indications que le magnésium soit un constituant capital de la réaction en cascade de la coagulation du sang et qu’il possède une activité procoagulante. Nous voulions examiner l’effet du magnésium sur la thromboélastographie (TEG) avant une greffe du foie.
Méthode
Nous avons recruté 27 patients devant subir une transplantation hépatique réglée. Pendant 5 min, 1,5 g de sulfate de magnésium dilué dans une solution salée ont été perfusés chez tous les patients dans la salle d’opération, avant l’incision cutanée. Les résultats de la TEG obtenus immédiatement avant et dix minutes après la perfusion ont été comparés.
Résultats
La TEG a montré une hypocoagulabilité générale avant le traitement au magnésium. Le temps K et les temps de coagulation (r + k) ont été significativement réduits de 641,6 ± 505,9 (moyenne ± écart type) à 464,6 ± 387,7 set de 1664,7 ± 772,5 à 1362,2 ± 487,1 s respectivement (P < 0,05); l’amplitude maximale et l’index TEG ont montré des hausses significatives de 38,5 ± 13,5 à 45,3 ± 12,2 mm et de-3,4 ± 2,6 à-1,9 ± 1,8 respectivement, après le traitement au magnésium (P < 0,01). Le temps R, l’angle alpha et LY60 n’étaient pas différents après le magnésium.
Conclusion
Le traitement au magnésium améliore significativement les résultats de la TEG, suggérant un état général hypocoagulable par rapport à la normale chez les patients sur le point de recevoir une transplantation hépatique.
Article PDF
Similar content being viewed by others
References
Diaz J, Acosta F, Parrilla P, et al. Serum ionized magnesium monitoring during orthotopic liver transplantation. Transplantation 1996; 61: 835–7.
Bennett MW, Webster NR, Sadek SA. Alterations in plasma magnesium concentrations during liver transplantation. Transplantation 1993; 56: 859–61.
Ranasinghe DN, Mallett SV. Hypomagnesaemia, cardiac arrhythmias and orthotopic liver transplantation. Anaesthesia 1994; 49: 403–5.
Sekiya F, Yoshida M, Yamashita T, Morita T. Magnesium (II) is a crucial constituent of the blood coagulation cascade. Potentiation of coagulant activities of factor IX by Mg2+ ions. J Biol Chem 1996; 271: 8541–4.
Matsuno K, Koyama M, Takeda H, et al. Cytosolic free magnesium concentration in human platelets. Thromb Res 1993; 69: 131–7.
Serebruany VL, Herzog WR, Schlossberg ML, Gurbel PA. Bolus magnesium infusion in humans is associated with predominantly unfavourable changes in platelet aggregation and certain haemostatic factors. Pharmacol Res 1997; 36: 17–22.
Samama CM, Thiry D, Elalamy I, et al. Perioperative activation of hemostasis in vascular surgery patients. Anesthesiology 2001; 94: 74–8.
Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth 1999; 83: 302–20.
Kang YG, Martin DJ, Marquez J, et al. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation. Anesth Analg 1985; 64: 888–96.
McNicol PL, Liu G, Harley ID, et al. Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography. Anaesth Intens Care 1994; 22: 659–65.
Gillies BS. Thromboelastography and liver transplantation. Semin Thromb Hemost 1995; 21(Suppl 4): 45–9.
Ames WA, McDonnell N, Potter D. The effect of ionised magnesium on coagulation using thromboelastography. Anaesthesia 1999; 54: 999–1006.
James MF, Neil G. Effect of magnesium on coagulation as measured by thrombelastography. Br J Anaesth 1995; 74: 92–4.
Harnett MJ, Datta S, Bhavani-Shankar K. The effect of magnesium on coagulation in parturients with preeclampsia. Anesth Analg 2001; 92: 1257–60.
Ruttmann TG, James MF, Viljoen JF. Haemodilution induces a hypercoagulable state. Br J Anaesth 1996; 76: 412–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Choi, J.H., Lee, J. & Park, C.M. Magnesium therapy improves thromboelastographic findings before liver transplantation: A preliminary study. Can J Anaesth 52, 156–159 (2005). https://doi.org/10.1007/BF03027721
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03027721