Dynamic functional clot formation in patients undergoing endoscopic mucosal resection.

Area of Science:

• Gastroenterology
• Hematology
• Surgical Innovation

Background:

• Endoscopic mucosal resection (EMR) uses electrocautery, which can induce fibrinolytic activity.
• Clinically significant post-EMR bleeding is a primary complication, yet its link to coagulation changes is unstudied.
• Viscoelastic hemostatic assays (VHAs) are not yet used to assess electrocautery's impact on coagulation during EMR.

Purpose of the Study:

• To investigate the effect of electrocautery during EMR on the coagulation cascade using VHAs.
• To analyze changes in plasminogen levels and clot characteristics post-EMR.
• To explore the potential of VHAs in predicting post-EMR bleeding risk.

Main Methods:

• Thrombelastometry and plasminogen level measurements were performed pre-EMR, 1 hour post-EMR, and 2 days post-EMR.
• Data were analyzed using repeated-measure ANCOVA, controlling for age, sex, BMI, and EMR site.
• Viscoelastic hemostatic assays (e.g., FIBTEM, EXTEM) assessed clot firmness and lysis.

Main Results:

• Plasminogen levels and clot firmness (FIBTEM A10, Maximum Clot Firmness) decreased 1 hour post-EMR, with increased lysis (EXTEM maximum lysis).
• These parameters normalized by 2 days post-EMR.
• One patient with significant bleeding showed persistently low clot firmness and A10 values at 2 days post-EMR.

Conclusions:

• Reduced plasminogen and clot quality post-EMR suggest impaired hemostasis.
• Viscoelastic hemostatic assays show potential for assessing fibrinolytic activity and bleeding risk after EMR.
• Further research with larger cohorts is needed to confirm bleeding risk prediction and understand plasminogen activation mechanisms.