Patients presented for OLT have multiple medical problems in addition to ESLD. Underlying disturbances in the normal haemostatic mechanism result from imbalances in the clotting and the fibrinolytic systems. Understanding the impact of co-existing disease and the physiological and the metabolic changes that occur throughout the various stages of the OLT procedure, is essential. In addition, precise monitoring of the haemostatic mechanism is required for optimal outcome. Improvements in surgical technique and management of the coagulation system by anaesthesiologists have decreased surgical time, blood loss, transfusion requirements, and adverse outcomes.

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