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[Changes in homeostasis during surgical liver resection]
1Service d'anesthésie-réanimation chirurgicale, hôpital de Hautepierre, Strasbourg, France.
Annales Francaises D'Anesthesie Et De Reanimation
|September 16, 1999
Summary
Liver resection can cause coagulopathy, not hyperfibrinolysis. Substitutive therapy with coagulation factors is preferred over antifibrinolytic agents like aprotinin in non-cirrhotic patients.
Area of Science:
- Hepatobiliary Surgery
- Anesthesiology
- Hematology
Background:
- Liver resection is a complex procedure with potential hemostatic challenges.
- Understanding coagulation changes during liver surgery is crucial for patient management.
Purpose of the Study:
- To evaluate hemostatic alterations during liver resection.
- To determine the appropriateness of antifibrinolytic therapy in this context.
Main Methods:
- Prospective study of 39 non-cirrhotic patients undergoing liver resection.
- Coagulation assessed using routine tests and thrombelastography.
- Aprotinin administered for unexplained bleeding; patients were compared.
Main Results:
- Most patients (32/39) showed moderate, non-significant coagulation changes.
- Seven patients experienced severe bleeding, treated with aprotinin.
- Bleeding patients exhibited significant modifications, including increased aPTT, TT, FDP, D-dimer, and decreased platelets.
Conclusions:
- Coagulation changes suggest dilution coagulopathy or DIC, rather than hyperfibrinolysis.
- Substitutive therapy with coagulation factors is recommended over antifibrinolytics.
- Systematic antifibrinolytic use in liver resection is questionable due to risks and cost.