The Challenging Management of an Intracardiac Thrombus in a Liver Transplant Patient at the Reperfusion Phase: A Case Report and Brief Literature Review

• Main Authors: Luigi Vetrugno, MD, Vittorio Cherchi, MD, PhD, Dario Lorenzin, MD, PhD, Francesco De Lorenzo, MD, Marco Ventin, MD, Victor Zanini, MD, Giovanni Terrosu, MD, Andrea Risaliti, MD, Umberto Baccarani, MD, PhD, Tiziana Bove, MD
• Format: Article
• Language: English
• Published: Wolters Kluwer 2021-10-01
• Series: Transplantation Direct
• Online Access: http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001200
• ISSN: 2373-8731

The exact origin of intracardiac thrombi formation during orthotopic liver transplant remains unknown. The altered balance between hypercoagulability, hypocoagulation, and endothelial dysfunction associated with end-stage liver disease is thought to play a pivotal role. Venous stasis, vascular clamping, and reperfusion could also contribute to clot formation. The incidence of intracardiac thrombi formation stands at 4.2%, associated with a mortality rate of 45.5%, and to date, no consensus exists regarding the best way to treat this complication. Intraoperative transesophageal echocardiography is the only effective method for diagnosing intracardiac thrombi formation early, while point-of-care coagulation testing could guide the coagulation management potentially improving patient outcomes.