Abstract
Background: With advent of surgical advancements like HIPEC several unstudied pathophysiological aspects need to be evaluated. We studied the trends in coagulation profile in patients undergoing CRS with HIPEC in the peri-operative period, utilizing Thromboelastography (TEG) in comparison with standard coagulation tests. The utility of TEG as a guide for transfusion of blood products was also evaluated. Materials and Methods: It was a Prospective observational Cohort study which included 30 consecutive patients undergoing CRS with HIPEC at RGCI in 2015. Methodology: Preoperatively standard coagulation tests were done as a baseline. Intra-operative arterial blood samples were collected for ABG, PT, APTT, and TEG at following time points: before starting of HIPEC, after completion of HIPEC and on 1 and 2 postoperative days. Statistical analysis was done using Chi-square test and unpaired t-test for categorical and continuous variables. Pearson’s correlation coefficient was calculated for analysing the correlation between the variables. P < 0.05 was considered statistically significant. Results: A strong correlation was observed between PT & R values of TEG. Similar correlation was also observed between the α angle, MA of TEG and platelet count throughout the peri-operative period. Immediately post HIPEC, we observe value of APPT decreases while the other parameters of coagulation profile showed a rising trend. R value showed rising trend after CRS, a dip after HIPEC followed by a rising trend on first post operative day which normalizes only after second post operative day. It gives a mixed picture of both hypo and hyper coagulable state. α angle, MA rise immediately after HIPEC and continue to rise till the second postoperative day. There was no requirement of transfusion of blood and blood products as guided by the TEG findings and no clinical evidence of any bleeding or thromboembolic episode occurred. Conclusion: To conclude, our study demonstrated TEG to be a useful and comprehensive tool to assess coagulopathy and accordingly guide blood product transfusion in patients undergoing CRS with HIPEC.
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