title: Perioperative coagulopathy in patients undergoing primary cytoreduction.
abstract: BACKGROUND
  This study was performed to determine the frequency of a perioperative coagulopathy in patients undergoing primary cytoreduction for ovarian cancer or carcinoma of the peritoneum and to identify variables that might predict this phenomenon.
  
  
  METHODS
  A retrospective review of 90 patients undergoing primary cytoreduction for ovarian cancer or carcinoma of the peritoneum was performed at Cedars Sinai Medical Center. Univariate analysis was performed to test the relationship between 15 variables and coagulopathy status.
  
  
  RESULTS
  Six patients (6.7%) developed a perioperative coagulopathy that was unrelated to preoperative subcutaneous heparin or dilution. Coagulation disturbances developed intraoperatively before packed erythrocyte replacement equivalent to one blood volume. Four patients (4.4%) required a repeat laparotomy due to continued postoperative bleeding unresponsive to blood component replacement. Vascular pedicles were not the cause of bleeding in any patient. Univariate analysis demonstrated a significant association between perioperative coagulopathy and the following variables: ascites volume (P = 0.009), estimated blood loss (P = 0.002), preoperative serum albumin less than 3.5 g/dl (P < 0.0001), and metastasis greater than 10 cm (P = 0.033).
  
  
  CONCLUSIONS
  Patients undergoing primary cytoreduction who have ascites, preoperative serum albumin less than 3.5 g/dl, or metastases greater than 10 cm may be at increased risk for development of a perioperative coagulopathy.
authors.affiliation: Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: J V
authors.initials: JV
authors.lastname: Brown
authors.forename: B Y
authors.initials: BY
authors.lastname: Karlan
authors.forename: J S
authors.initials: JS
authors.lastname: Greenspoon
authors.forename: M H
authors.initials: MH
authors.lastname: Rosove
authors.forename: L D
authors.initials: LD
authors.lastname: Lagasse
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology*; D016063:Blood Loss, Surgical; D002291:Carcinoma, Papillary / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood; D011517:Prothrombin Time; D012189:Retrospective Studies