Alterations in coagulation following major liver resection

Area of Science:

• Hepatobiliary Surgery
• Coagulation Science
• Thrombosis Research

Background:

• Major liver resection often results in elevated international normalized ratio (INR), typically presumed to indicate bleeding risk.
• Paradoxically, these patients exhibit an increased incidence of venous thromboembolic events (VTEs).
• Conventional coagulation tests may not accurately reflect the true hemostatic balance in the postoperative period.

Purpose of the Study:

• To prospectively investigate serial changes in coagulation parameters following major hepatic resection.
• To elucidate the hemostatic balance and identify factors contributing to the prothrombotic state in early postoperative recovery.

Main Methods:

• Prospective observational study design.
• Serial analysis of coagulation parameters, including thrombin generation and thromboelastometry.
• Measurement of procoagulant and anticoagulant factors (II, V, VII, X, VIII, Von Willebrand factor, protein C, antithrombin).

Main Results:

• Thrombin generation and thromboelastometry remained within normal limits throughout the study.
• Procoagulant factors II, V, VII, and X initially decreased, with V and X normalizing by postoperative day five.
• Factor VIII and Von Willebrand factor levels significantly increased postoperatively.
• Anticoagulant proteins C and antithrombin remained significantly depressed on postoperative day five.

Conclusions:

• The early postoperative period after major liver resection is characterized by a prothrombotic hemostatic imbalance.
• Elevated procoagulant factors and depressed anticoagulant factors contribute to this prothrombotic environment.
• Findings challenge the reliance on conventional coagulation tests and highlight the need for advanced monitoring to assess VTE risk.