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Anaesthesia. 2016 Jun;71(6):657-68. doi: 10.1111/anae.13459. Epub 2016 Mar 31.

Alterations in coagulation following major liver resection.

Author information

1
Department of Anaesthesia, Royal Free Hospital, London, UK.
2
Department of Anaesthesia, Brighton and Sussex University Hospitals, Brighton, UK.
3
Department of Anaesthesia, University College London Hospital, London, UK.
4
Department of Anaesthesia, Kings College Hospital, London, UK.
5
University Department of Surgery, Royal Free Campus, University College London, London, UK.
6
Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
7
University of Malta, Tal-Qroqq, Msida, Malta.

Abstract

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.

KEYWORDS:

coagulation factors; elevated INR; hepatic resection

PMID:
27030945
DOI:
10.1111/anae.13459
[Indexed for MEDLINE]
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