Coagulation in liver surgery: an observational haemostatic profile and thromboelastography study

Area of Science:

• Hepatobiliary surgery
• Hemostasis and thrombosis
• Coagulation medicine

Background:

• Liver resection significantly impacts patient hemostasis.
• International normalized ratio (INR) is commonly used to assess hemostasis post-liver resection.
• The complexity of hemostasis post-liver resection may not be fully captured by INR.

Purpose of the Study:

• To prospectively evaluate the hemostatic profile after liver resection.
• To determine if INR measurements can reliably guide post-operative thromboprophylaxis.
• To investigate the relationship between coagulation parameters and clinical outcomes.

Main Methods:

• Prospective cohort study of patients undergoing liver resection.
• Perioperative assessment of coagulation parameters including INR, PT, aPTT, fibrinogen, d-dimer, vWF, and specific clotting factors.
• Thromboelastography (TEG) was used to assess global hemostatic function.
• Clinical follow-up for thromboembolism and hemorrhage.

Main Results:

• Postoperative INR elevation was significant, with 17.1% of patients having INR >1.5 on postoperative day 1.
• Clotting factors II and X remained within normal ranges, while factor VII showed transient reduction.
• Thromboelastogram parameters were consistently normal or supranormal.
• One case of post-hepatectomy hemorrhage occurred despite a normal coagulation profile; two patients experienced pulmonary embolism.

Conclusions:

• Hemostasis following liver resection is intricate and not accurately represented by INR alone.
• INR is insufficient for guiding the initiation of chemical thromboprophylaxis in the immediate postoperative period after liver resection.
• Further research is needed to establish optimal thromboprophylaxis strategies post-liver resection.