Mechanisms of Development of Hemostatic Disorders after Liver Resection

Abstract

Objective: to reveal the mechanisms of development of hemostatic disorders after liver resection. Material and methods. One hundred and twenty cases of liver resections for primary hepatic cancer were retrospectively analyzed. Patients with an uncomplicated postoperative period (Group 1.1), isolated hepatic coagulopathy (Group 1.2), and developed multiple organ dysfunction (MOD) (Group 1.3) were analyzed. The values of hemostasis, hemodynamics, and oxygen status (oxygen delivery, uptake, and utilization) and biochemical and acid-base homeostatic parameters were monitored in these patients twice daily. Results. A significant reduction in Factor VII levels within the immediate hours after surgery was an early hemostasiological marker of the development of hepatic coagulopathy (isolated or as part of MOD). In patients with further evolved MOD, the level of hemostatic system activation markers (fibrin degradation products and D-dimer) was increased from the first 24 postoperative hours, which suggested the development of disseminated intravascular coagulation (DIC) concurrent with hepatic coagulopathy. The development of energy deficiency was at least 24 hours ahead of the clinical manifestation of hepatic coagulopathy and DIC in the patients undergoing liver resection. Hypoxic energy deficiency (the decreased delivery and uptake of oxygen and its higher utilization coefficient, and elevated blood lactate values) was a predictor of the development of isolated hepatic coagulopathy. Further worsening of hypoxic energy deficiency (an increase in blood lactate values and a reduction in venous oxygen saturation) or its transformation to enzyme energy deficiency (lowered oxygen uptake and utilization) was a predictor of DIC development. Conclusion. In the patients undergoing liver resection, the development of energy deficiency is at least 24 hours ahead of the clinical manifestation of hepatic coagulopathy (which evolves in the presence of hypoxic – energy deficiency) and DIC (which manifests in the presence of enzyme energy deficiency). To correct the existing Адрес для к°рреспонденции (Correspondence to): energy deficiency is the key condition to determine the effectiveness of performed hemostasis-modulating therapy. Key words: liver resection, hepatic coagulopathy, disseminated intravascular coagulation, energy deficiency.