Alterations in coagulation following major liver resection

Summary The international normalised ratio is frequently raised in patients who have undergone major liver resection, and is assumed to represent a potential bleeding risk. However, these patients have an increased risk of venous thromboembolic events, despite conventional coagulation tests indicati...

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Bibliographic Details
Published in:Anaesthesia 2016-06, Vol.71 (6), p.657-668
Main Authors: Mallett, S. V., Sugavanam, A., Krzanicki, D. A., Patel, S., Broomhead, R. H., Davidson, B. R., Riddell, A., Gatt, A., Chowdary, P.
Format: Article
Language:English
Subjects:
Aged
Anticoagulants
Blood Coagulation
Blood Coagulation Factors - analysis
coagulation factors
elevated INR
Female
Health risk assessment
Hepatectomy - adverse effects
hepatic resection
Humans
International Normalized Ratio
Liver
Male
Middle Aged
Postoperative period
Prospective Studies
Protein C - analysis
Thrombin - biosynthesis
Thrombosis
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Summary:Summary The international normalised ratio is frequently raised in patients who have undergone major liver resection, and is assumed to represent a potential bleeding risk. However, these patients have an increased risk of venous thromboembolic events, despite conventional coagulation tests indicating hypocoagulability. This prospective, observational study of patients undergoing major hepatic resection analysed the serial changes in coagulation in the early postoperative period. Thrombin generation parameters and viscoelastic tests of coagulation (thromboelastometry) remained within normal ranges throughout the study period. Levels of the procoagulant factors II, V, VII and X initially fell, but V and X returned to or exceeded normal range by postoperative day five. Levels of factor VIII and Von Willebrand factor were significantly elevated from postoperative day one (p < 0.01). Levels of the anticoagulants, protein C and antithrombin remained significantly depressed on postoperative day five (p = 0.01). Overall, the imbalance between pro‐ and anticoagulant factors suggested a prothrombotic environment in the early postoperative period.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.13459