The international normalized ratio overestimates coagulopathy in patients after major hepatectomy

Scott G. Louis, Jeffrey S. Barton, Gordon M. Riha, Susan L. Orloff, Brett C. Sheppard, Rodney F. Pommier, Samantha J. Underwood, Jerome A. Differding, Martin A. Schreiber, Kevin Billingsley

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: The International Normalized Ratio (INR) is commonly used to guide therapy after hepatectomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a decreased incidence of hypocoagulability in this patient population. Methods: Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5. Results: Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C. Conclusions: TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population.

Original languageEnglish (US)
Pages (from-to)723-727
Number of pages5
JournalAmerican journal of surgery
Issue number5
StatePublished - May 2014


  • Coagulation
  • Hepatectomy
  • INR
  • Thrombelastography

ASJC Scopus subject areas

  • Surgery


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