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Thromb Haemost 2022; 122(10): 1662-1672
DOI: 10.1055/a-1839-0355
Coagulation and Fibrinolysis

Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

Petros Tzimas
1   Department of Anaesthesia and Postoperative Intensive Care, Faculty of Medicine, University of Ioannina, Ioannina, Greece
,
Eleftheria Lefkou
2   Research Group « Cancer, Haemostasis, Angiogenesis», Centre de recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
,
Agathi Karakosta 
1   Department of Anaesthesia and Postoperative Intensive Care, Faculty of Medicine, University of Ioannina, Ioannina, Greece
,
Stellios Argyrou
3   Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
,
Evangelia Papapetrou
4   Hematology Laboratory, University Hospital of Ioannina, Ioannina, Greece
,
Despoina Pantazi
3   Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
,
Alexandros Tselepis
3   Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
,
Patrick Van Dreden
2   Research Group « Cancer, Haemostasis, Angiogenesis», Centre de recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
5   Clinical Research Department, Diagnostica Stago, Gennevilliers, France
,
Panagiota Stratigopoulou
1   Department of Anaesthesia and Postoperative Intensive Care, Faculty of Medicine, University of Ioannina, Ioannina, Greece
,
Grigoris Gerotziafas
2   Research Group « Cancer, Haemostasis, Angiogenesis», Centre de recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie (IUC), Sorbonne Université, Paris, France
6   Biological Hematology Department, Thrombosis and Haemostasis Centre, Tenon University Hospital, Sorbonne Université, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
,
Georgios Glantzounis
7   HPB Unit, Department of Surgery, Faculty of Medicine, University of Ioannina, Ioannina, Greece
› Author Affiliations Funding None.
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Abstract

Hepatectomy-induced coagulation disturbances have been well studied over the past decade. Cumulative evidence supports the superiority of global coagulation analysis compared with conventional coagulation tests (i.e., prothrombin time or activated partial thromboplastin time) for clinical decision making. Cancer, however, represents an acquired prothrombotic state and liver resection for cancer deserves a more thorough investigation. This prospective observational study was conducted to assess the perioperative coagulation status of patients undergoing major hepatectomies for primary or metastatic hepatic malignancy. Patients were followed up to the 10th post-operative day by serial measurements of conventional coagulation tests, plasma levels of coagulation factors, and thrombin generation assay parameters. An abnormal coagulation profile was detected at presentation and included elevated FVIII levels, decreased levels of antithrombin, and lag time prolongation in thrombin generation. Serial hematological data demonstrated increased Von Willebrand factor, FVIII, D-dimer, fibrinogen and decreased levels of natural anticoagulant proteins in the early post-operative period predisposing to a hyper-coagulable state. The ratio of the anticoagulant protein C to the procoagulant FVIII was low at baseline and further declined post-operatively, indicating a prothrombotic state. Though no bleeding complications were reported, one patient experienced pulmonary embolism while under thromboprophylaxis. Overall, patients with hepatic carcinoma presenting for elective major hepatectomy may have baseline malignancy-associated coagulation disturbances, aggravating the hyper-coagulable state documented in the early post-operative period.

Keywords

coagulation factors - coagulation inhibitors - malignancy - liver surgery

Supplementary Material



Publication History

Received: 02 December 2021

Accepted: 26 April 2022

Accepted Manuscript online:
28 April 2022

Article published online:
18 June 2022

© 2022. Thieme. All rights reserved.

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