Coagulopathy after a liver resection: Is it over diagnosed and over treated?

Jeffrey S. Barton, Gordon M. Riha, Jerome A. Differding, Samantha J. Underwood, Jodie L. Curren, Brett Sheppard, Rodney Pommier, Susan Orloff, Martin Schreiber, Kevin Billingsley

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background Prothrombin time-international normalized ratio (PT-INR) is widely utilized to guide plasma therapy and initiation of thromboprophylaxis after a hepatectomy. Thrombelastography (TEG) monitors shear elasticity, which is sensitive to cellular and plasma components in blood, allowing for functional assessment of the life of the clot. The objective of this study was to prospectively compare PT-INR and TEG in liver resection patients. Methods Forty patients were enrolled before undergoing an elective hepatectomy. Patients underwent a liver resection utilizing a low central venous pressure (CVP) anaesthetic technique and intermittent Pringle manoeuver. PT-INR and TEG were drawn prior to incision, post-operatively, and post-operative days 1, 3 and 5. Results All post-operative PT-INR values increased significantly when compared with pre-operative PT-INR (P <0.01). The time of onset to clot (R-value) decreased significantly at the post-operative time point (P = 0.04), consistent with a relative hypercoagulability. Subsequent R-values were not different compared with the pre-operative R-value. The strength of the clot (maximum amplitude, MA) was unchanged when comparing pre- and post-operative time points. Discussion In spite of an elevation in PT-INR, patients undergoing a liver resection demonstrated a brief hypercoagulable state, followed by normal coagulation function based on TEG. These data call into question the practice of utilizing PT-INR to guide plasma transfusion and timing of prophylactic anticoagulation after a liver resection.

Original languageEnglish (US)
Pages (from-to)865-871
Number of pages7
JournalHPB
Volume15
Issue number11
DOIs
StatePublished - Nov 2013

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International Normalized Ratio
Prothrombin Time
Thrombelastography
Operative Time
Liver
Hepatectomy
Central Venous Pressure
Thrombophilia
Elasticity
Anesthetics

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Barton, J. S., Riha, G. M., Differding, J. A., Underwood, S. J., Curren, J. L., Sheppard, B., ... Billingsley, K. (2013). Coagulopathy after a liver resection: Is it over diagnosed and over treated? HPB, 15(11), 865-871. https://doi.org/10.1111/hpb.12051

Coagulopathy after a liver resection : Is it over diagnosed and over treated? / Barton, Jeffrey S.; Riha, Gordon M.; Differding, Jerome A.; Underwood, Samantha J.; Curren, Jodie L.; Sheppard, Brett; Pommier, Rodney; Orloff, Susan; Schreiber, Martin; Billingsley, Kevin.

In: HPB, Vol. 15, No. 11, 11.2013, p. 865-871.

Research output: Contribution to journalArticle

Barton JS, Riha GM, Differding JA, Underwood SJ, Curren JL, Sheppard B et al. Coagulopathy after a liver resection: Is it over diagnosed and over treated? HPB. 2013 Nov;15(11):865-871. https://doi.org/10.1111/hpb.12051
Barton, Jeffrey S. ; Riha, Gordon M. ; Differding, Jerome A. ; Underwood, Samantha J. ; Curren, Jodie L. ; Sheppard, Brett ; Pommier, Rodney ; Orloff, Susan ; Schreiber, Martin ; Billingsley, Kevin. / Coagulopathy after a liver resection : Is it over diagnosed and over treated?. In: HPB. 2013 ; Vol. 15, No. 11. pp. 865-871.
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N2 - Background Prothrombin time-international normalized ratio (PT-INR) is widely utilized to guide plasma therapy and initiation of thromboprophylaxis after a hepatectomy. Thrombelastography (TEG) monitors shear elasticity, which is sensitive to cellular and plasma components in blood, allowing for functional assessment of the life of the clot. The objective of this study was to prospectively compare PT-INR and TEG in liver resection patients. Methods Forty patients were enrolled before undergoing an elective hepatectomy. Patients underwent a liver resection utilizing a low central venous pressure (CVP) anaesthetic technique and intermittent Pringle manoeuver. PT-INR and TEG were drawn prior to incision, post-operatively, and post-operative days 1, 3 and 5. Results All post-operative PT-INR values increased significantly when compared with pre-operative PT-INR (P <0.01). The time of onset to clot (R-value) decreased significantly at the post-operative time point (P = 0.04), consistent with a relative hypercoagulability. Subsequent R-values were not different compared with the pre-operative R-value. The strength of the clot (maximum amplitude, MA) was unchanged when comparing pre- and post-operative time points. Discussion In spite of an elevation in PT-INR, patients undergoing a liver resection demonstrated a brief hypercoagulable state, followed by normal coagulation function based on TEG. These data call into question the practice of utilizing PT-INR to guide plasma transfusion and timing of prophylactic anticoagulation after a liver resection.

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