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In response to intraoperative heparin prophylaxis during liver transplantation.

We firmly agree with the writers that our conclusions share the limitations of all retrospective analyses. Our study took advantage of natural quasi-experiment, over an eight-year period, when intravenous heparin administration was introduced approximately halfway through in response to the problem of intracardiac thrombus. We could not provide an anesthesia protocol in our methods section as our management evolved over the eight year period of the study, as might be expected at an academic, large-volume liver transplant center. Although we agree that a routine measurement of heparin effect would be ideal, to our knowledge there is no accurate, practical test for the effect of unfractionated heparin in the patient with end-stage liver disease. This article is protected by copyright. All rights reserved.