title: Evaluation of hemostatic factors in patients undergoing major hepatic resection and other major abdominal surgeries.
abstract: The aim of this study was to evaluate the role for additional testing of coagulation in perioperative management of patients undergoing major hepatic resection. Major outcome measures were perioperative measurements of hemostatic factors (activated partial prothrombin time [aPTT], prothrombin  time/international normalized ratio, fibrinogen, antithrombin-III). We conducted a prospective, single-blind study comparing hemostatic factors in patients undergoing major hepatectomy, Whipple procedures, and other gastrointestinal operations. Ninety-five consecutive patients were enrolled.  No values differed significantly at baseline. Immediately postoperative, only international normalized ratio was significantly lower comparing major hepatectomy with Whipple (P < 0.005) and other procedures (P < 0.0032). Twenty-four hours postoperative, antithrombin-III  was lower for major hepatectomy than Whipple (P < 0.028) and others (P < 0.0001); fibrinogen was lower compared with Whipple (P < 0.014) and others (P < 0.0009); international normalized ratio was lower to compared with Whipple (P < 0.0001)  and others (P < 0.0001). aPTT measurements never differed significantly between groups at any time. Antithrombin-III and fibrinogen only correlated with international normalized ratio and aPTT for the other procedures. Additional hemostatic values beyond the standard evaluations  of aPTT and international normalized ratio are needed to better assess patients undergoing major hepatic surgery.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.forename: Ken A
authors.initials: KA
authors.lastname: Tanaka
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
mesh_terms: D000005:Abdomen / Q000601:surgery*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006487:Hemostasis / Q000502:physiology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method
chemical_list: D001779:Blood Coagulation Factors