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Thrombelastographic evaluation of coagulation in transurethral prostatectomy
Author(s) -
Bell C.R.W.,
Cox D.J.A.,
Murdock P.J.,
Sullivan M.E.,
Pasi K.J.,
Morgan R.J.
Publication year - 1996
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1996.19313.x
Subject(s) - medicine , fibrinolysis , prostatectomy , blood volume , urology , thrombelastography , thromboelastography , coagulation , surgery , anesthesia , prostate , cancer
Objective To assess the changes in overall coagulation status and define the degree of systemic fibrinolysis occurring in patients undergoing transurethral prostatectomy (TURP). Patients and methods Thirty patients undergoing TURP, 23 for benign prostatic hyperplasia and seven for prostatic carcinoma, were studied prospectively. Serial venous blood samples were taken using the two‐syringe technique. Samples were taken before, during and at intervals up to 72 h and 10–14 days after surgery. Thrombelastography (TEG) was performed on native whole blood samples. Peri‐operative blood loss was assessed, until the catheter was removed, by photometric estimation of the haemoglobin content of the irrigant fluid and the measurement of clot volume. Results There was no evidence of fibrinolysis (TEG Percentage Clot Lysis Ly 60 >15%) in any patient over the whole peri‐operative period. There was a significant change in the mean TEG variables towards hypercoagulation from 3 h until 10–14 days post‐operatively, compared with the pre‐operative values ( P <0.05). There was a significant correlation between blood loss and clot volume. Conclusion These results question the role of systemic fibrinolysis in primary and secondary haemorrhage following TURP and thus the rationale of using antifibrinolytics in these patients. The persistent hypercoagulable state post‐operatively indicates a possible role of hypercoagulability in clot retention.