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Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
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Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by
Mari Tuovila1, Tiina Erkinaro1, Heikki Takala2
1Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
Summary
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) initially causes hypocoagulation, as shown by thromboelastography (TEG) and lab tests. However, TEG reveals accelerated coagulation during HIPEC itself.
Area of Science:
- Surgical Oncology
- Thromboembolism Research
- Hemostasis and Coagulation Studies
Background:
- Postoperative thromboembolism is a major complication following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), leading to prolonged recovery.
- Thromboelastography (TEG) is a valuable tool for detecting hypercoagulable states and predicting thromboembolic events.
- Understanding the impact of CRS and HIPEC on coagulation is crucial for patient management and risk mitigation.
Purpose of the Study:
- To assess the dynamic changes in thromboelastography (TEG) parameters during and after cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).
- To evaluate the correlation between TEG findings and conventional coagulation tests (platelets, P-TT, aPTT) in patients undergoing CRS and HIPEC.
Main Methods:
- Blood samples were collected from 15 patients undergoing CRS and HIPEC at multiple time points: preoperatively, end of CRS, during HIPEC, and end of operation.
- TEG parameters including reaction time (R), kinetics time (K), angle (α), maximum amplitude (MA), and lysis percent at 60 min (LY60) were analyzed.
- Conventional coagulation tests (platelets, P-TT, aPTT) were also performed before and after CRS.
Main Results:
- During CRS, a significant reduction in mean maximum amplitude (MA) was observed (p=0.001), alongside a decrease in mean platelets (p<0.001) and P-TT (p<0.001), indicating hypocoagulation.
- During HIPEC, mean reaction time (R) and kinetics time (K) shortened (p=0.015 and p=0.018, respectively), and the angle (α) increased (p=0.005).
- These changes during HIPEC suggest an acceleration in the initiation and kinetics of thrombin formation.
Conclusions:
- Both TEG and conventional laboratory tests indicate a state of hypocoagulation during the CRS phase of the procedure.
- Conversely, the HIPEC phase is associated with hypercoagulable changes, characterized by accelerated coagulation initiation and thrombin generation.
- These findings highlight the dynamic and complex hemostatic alterations occurring during CRS and HIPEC, necessitating careful monitoring.
