The changes in coagulation profile and epidural catheter safety for living liver donors: a report on 6 years of our experience.
The use of epidural catheters has been a subject of active debate in living liver donors because of the possible postoperative coagulation derangement and the subsequent risk of epidural hematoma. The aim of this study was to evaluate the safety of epidural catheters in relation to the changes in coagulation profile based on a review of previously published literature and the results of our 360 donors. In both the literature and in our cases, platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) in cases of heparin administration showed significant changes (P < 0.05), especially after right lobectomy. Platelet count reached its nadir on postoperative day (POD) 2-3, while PT and aPTT reached their peaks on POD 1-2 and at the end of the operation, respectively. In our donors, the ranges of platelet count, PT, and aPTT for the first 3 PODs were 54-359 x10/microL, 0.99-2.38 international normalized ratio (INR), and 25.9-300 seconds, respectively, and of note, 5 donors (1.4%) had a platelet count of <80 x 10/microL and 9 donors (2.5%) had a PT of >2.0 INR. Epidural catheterizations were performed in 242 donors, and the catheters were removed on POD 3-4 in 177 donors (73.1%). Mean (range) of platelet count, PT, and aPTT on the day of catheter removal were 168.4 +/- 42.9 (82-307) x 10/microL, 1.33 +/- 0.18 (0.99-1.93) INR, and 40.9 +/- 4.8 (32.0-70.6) seconds, respectively. No epidural hematoma was observed in this study. In conclusion, the discreet use of epidural catheters in live liver donors, in spite of postoperative coagulation derangements, appears to be safe regardless of the type of hepatectomy performed.
Choi
Soo Joo
SJ
Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Gwak
Mi Sook
MS
Ko
Justin Sang
JS
Kim
Gaab Soo
GS
Ahn
Hyun Joo
HJ
Yang
Mikyung
M
Hahm
Tae Soo
TS
Lee
Sang Min
SM
Kim
Myung Hee
MH
Joh
Jae Won
JW
D000328:Adult; D001777:Blood Coagulation; D002404:Catheterization / Q000379:methods*; D003029:Coagulants / Q000494:pharmacology*; D004824:Epidural Space / Q000473:pathology; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D019934:International Normalized Ratio; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D012306:Risk; D013997:Time Factors
D003029:Coagulants; D006493:Heparin