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Coagulopathy post peritoneovenous shunt.

H H LeVeen, M Ip, N Ahmed

    Annals of Surgery
    |March 1, 1987
    PubMed
    Summary
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    Peritoneovenous shunts (PVS) can be a life-saving treatment for ascites in cirrhosis patients. Proper management, including using epsilon-aminocaproic acid (EACA), prevents dangerous post-shunt coagulopathy (PSC).

    Area of Science:

    • Hepatology
    • Surgical Complications
    • Coagulation Disorders

    Background:

    • Cirrhosis patients with ascites historically faced a grim prognosis, with high mortality rates within months of diagnosis.
    • Peritoneovenous shunts (PVS) offer a treatment option, but concerns about post-shunt coagulopathy (PSC) have limited their use.
    • Ascites development is linked to diminished blood volume and abnormal sodium retention, highlighting the need for effective fluid management.

    Purpose of the Study:

    • To investigate the mechanisms behind post-shunt coagulopathy (PSC) following peritoneovenous shunt (PVS) placement for cirrhotic ascites.
    • To evaluate the efficacy of epsilon-aminocaproic acid (EACA) and clotting factors in preventing and treating PSC.
    • To demonstrate that PSC is a distinct entity from disseminated intravascular coagulopathy (DIC) and can be effectively managed.

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    Main Methods:

    • Analysis of patient data from over 150 PVS procedures, comparing outcomes with and without ascitic fluid management.
    • In vitro studies using thromboelastogram (TEG) to assess the effect of ascitic fluid on blood coagulation.
    • Administration of epsilon-aminocaproic acid (EACA) and clotting factors to patients experiencing or at risk of PSC.

    Main Results:

    • Disposal of ascitic fluid during surgery significantly reduced the incidence of PSC, from 7/98 cases to 1.3% (1/77) mild cases.
    • Ascitic fluid in vitro promotes clot lysis, a process counteracted by EACA, which also normalizes TEG results.
    • EACA and clotting factors effectively arrested coagulopathy in treated patients, preventing mortality from PSC.

    Conclusions:

    • Post-shunt coagulopathy (PSC) is a distinct complication of peritoneovenous shunts (PVS) caused by peritoneal serosa-secreted tissue plasminogen activator (TPA).
    • Epsilon-aminocaproic acid (EACA) is the effective antidote for PSC, differing from heparin used for disseminated intravascular coagulopathy (DIC).
    • Proper management, including ascitic fluid disposal and EACA administration, eliminates PSC as a deterrent to PVS, improving outcomes for cirrhotic patients.