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Risk factors for coagulopathy after liver resection
Tina Ramspoth1, Anna B Roehl1, Stephan Macko1
1Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany.
Journal of Clinical Anesthesia
|December 4, 2014
Summary
Risk factors for coagulopathy after liver resection include elevated preoperative international normalized ratio, high postoperative lactate, and larger resected liver weight. Caution is advised for extensive resections.
Area of Science:
- Hepatobiliary Surgery
- Anesthesiology
- Coagulation Disorders
Background:
- Liver resection is a complex procedure associated with potential complications.
- Coagulopathy, a disruption of the normal blood clotting process, can occur post-liver resection.
- Identifying risk factors for coagulopathy is crucial for patient management.
Purpose of the Study:
- To identify independent risk factors for developing coagulopathy following liver resection.
- To characterize the incidence and time course of coagulopathy after liver resection.
Main Methods:
- Retrospective cohort study of 147 patients undergoing liver resection.
- Coagulopathy defined by international normalized ratio (INR) ≥1.4, platelet count <80,000/μL, or partial thromboplastin time >38 seconds.
- Patients categorized into no, temporary, or persistent coagulopathy groups.
Main Results:
- 65.8% had no coagulopathy, 28.2% temporary, and 6% persistent coagulopathy.
- Independent predictors of coagulopathy included preoperative INR, postoperative peak lactate, and resected liver weight.
- Patients with persistent coagulopathy had higher transaminases and transfusion volumes.
Conclusions:
- Preoperative INR, postoperative lactate, and resected liver weight are key predictors of coagulopathy.
- Extended liver resections (≥3 segments) and elevated postoperative lactate warrant caution.
- Epidural anesthesia may be feasible, but caution is advised in patients with pre-existing liver disease.
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