Abstract
Background: Coagulopathy can associate right hepatotomy in cirrhotic patients. Methods: 20 cirrhotic patients were prospectively studied for 10 days with rotational thromboelastometry (ROTEM) and standard coagulation tests (SCTs). EXTEM and INTEM of ROTEM represent extrinsic and intrinsic coagulation pathways respectively. FIBTEM (ROTEM) represents fibrinogen activity. SCTS include Prothrombin time (PT), activated partial thromboplastin time (aPPT), fibrinogen and platelets. Results: Age and body mass index were 55.9 ± 6.9 years and 23.7 ± 3.1 Kg/m2. Males: Female (11:9). ROTEM parameters were normal except for a prolonged clotting time (CT) on day 1 and 3, associated with a normal clotting formation time (CFT). CT and PT were maximum on day 1 (86.25+15.7 mm and 17.2 ± 2.2 sec, p 0.05 respectively). CT and CFT of (INTEM) were also not in correlation with aPTT (r=0.16, r=0.21, p>0.05 respectively). Fibrinogen correlated with maximum clot firmness (MCF) of FIBTEM (r=0.5, p 0.05). Model of end stage liver disease (MELD) score correlated with preoperative CFT and MCF (EXTEM) (r=0.47, r=-0.48, p<0.05) respectively.
Highlights
Removal of a considerable hepatic mass during right hepatotomy could reduce the hepatic synthesis of clotting factors resulting in a hypocoagulable state or alternatively hypercoagulable from the diminished synthesis of anticoagulants, extensive tissue trauma and acute phase response [1].During major liver surgery, different coagulation problems often appear
Postoperative coagulopathy is currently diagnosed by abnormalities in standard coagulation tests (SCT) such as the prothrombin time (PT), partial thromboplastin time (PTT) and low platletes count [6]
The introduction of thrombelastographic studies (TEG) as a point of care coagulation test can enable a complete evaluation of the whole process of clot initiation, formation and stability, using whole blood with all its components in patients subjected to hepatectomy [7]
Summary
This may be due to the procedure itself, or to the associated liver dysfunction, which causes both qualitative and quantitative alterations in pro-coagulants, anticoagulants and platelets [2,3,4]. The introduction of thrombelastographic studies (TEG) as a point of care coagulation test can enable a complete evaluation of the whole process of clot initiation, formation and stability, using whole blood with all its components in patients subjected to hepatectomy [7]. Rotational thromboelastometry is a development of TEG coagulation monitoring device that is based on the viscoelastic properties of the whole blood and currently used to monitor coagulation in various clinical scenarios [8]. Coagulopathy can associate right hepatotomy in cirrhotic patients
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