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Coagulation in liver surgery: an observational haemostatic profile and thromboelastography study
Author(s) -
Oo June,
Allen Megan,
Loveday Benjamin P. T.,
Lee Nora,
Knowles Brett,
Riedel Bernhard,
Burbury Kate,
Thomson Benjamin
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15912
Subject(s) - medicine , thromboelastography , partial thromboplastin time , prothrombin time , coagulation , fibrinogen , hepatectomy , prospective cohort study , surgery , hemostasis , coagulation testing , von willebrand factor , liver disease , gastroenterology , resection , platelet
Background International normalized ratio (INR) is used as a marker of the haemostatic status following liver resection. However, the impact of liver resection on haemostasis is complex and beyond what can be measured by INR. This study aimed to prospectively assess haemostatic profile following liver resection and determine if INR measurement can safely guide post‐operative thromboprophylaxis. Methods In this prospective cohort study, patients undergoing liver resection had coagulation parameters (International normalised ratio (INR), prothrombin time (PT), activated partial thromboplastin time, fibrinogen, d‐dimer, von Willebrand factor antigen, procoagulant activity of phospholipids and clotting factors II, VII, VIIIc, IX and X) and thromboelastogram parameters assessed perioperatively. Clinical follow‐up assessed for thromboembolism and haemorrhage. Results In the 41 patients included, INR was significantly ( P < 0.0001) elevated post‐operatively, and INR >1.5 was observed in seven of 41 (17.1%) on post‐operative day 1 and one of 41 (2.4%) patients on post‐operative day 3, respectively. Factor VII levels showed transient reduction but other factors, especially factors II and X, remained within normal range following liver resection. Thromboelastogram parameters remained normal or supranormal for all patients at all time points. One incident of post‐hepatectomy haemorrhage occurred, despite a normal coagulation profile. Two patients suffered late pulmonary embolic episodes. Conclusion Post liver resection haemostasis is complex and poorly reflected by INR, which should not guide initiation of chemical thromboprophylaxis in the immediate post‐operative period.