Platelet Count and INR Profile after Hepatic Resection in Cirrhotic Patients: Implications for Epidural Analgesia

Abstract

Introduction: Since cirrhotic patients undergoing hepatic resection are at increased risk of developing postoperative coagulopathy, epidural catheter placement in this group of patients is still debated. This retrospective study aimed to evaluate postoperative course of coagulation parameters after surgical hepatic resection in cirrhotic patients and their relation to extent of resection and perioperative risk factors. Methods: Perioperative data from 232 hepatic resections performed in cirrhotic patients were reviewed. We defined postoperative coagulopathy the occurrence of a postoperative platelet count < 100,000/µL and/or INR value ≥ 1.5. Logistic regression was used to assess the association between postoperative coagulopathy and several potential risk factors, while general linear model for repeated measures was used to compare postoperative course of coagulation parameters. Results: 98 patients (42.24%) showed an abnormal coagulation profile at least once during the first 7 postoperative days. None of the analyzed parameters resulted statistically associated with the development of postoperative coagulopathy. Postoperative INR course was significantly different in patients undergoing minor resections with better values, while platelet count was not. Conclusions: Postoperative coagulopathy after hepatic resections is a common issue in cirrhotic patients, which may limit the feasibility of invasive procedures such as epidural catheter placement. Multivariate analysis didn't show any association between investigated risk factors and postoperative coagulopathy. Postoperative course of coagulation parameters in cirrhotic patients with normal preoperative coagulation tests undergoing minor liver resection seems to be compatible with epidural catheter placement and management.