Alterations in coagulation following major liver resection

• Published in: Anaesthesia Vol. 71; no. 6; pp. 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: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2016
• 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; coagulation factors; elevated INR; hepatic resection
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.13459

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.