title: Increased von Willebrand Factor to ADAMTS13 ratio as a predictor of thrombotic complications following a major hepatectomy.
abstract: OBJECTIVE
  To investigate the association between changes in procoagulant/fibrinolytic factors and thrombotic complications following a major hepatectomy. Little information is available regarding the changes in procoagulant/fibrinolytic factors (such as the von Willebrand factor [vWF] and a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 [ADAMTS13]), following a major hepatectomy.
  
  
  METHODS
  Patients who underwent a major hepatectomy from 2010 to 2011 were enrolled. Patients who underwent a pancreatoduodenectomy (PD) during the same period were also observed as controls, for whom operation time and amount of intraoperative blood loss were comparable to those of the patients who underwent a major hepatectomy. Blood samples were prospectively collected to measure various procoagulant/fibrinolytic factors, including vWF and ADAMTS13.
  
  
  METHODS
  Nagoya University Hospital, Japan.
  
  
  METHODS
  A total of 50 patients who underwent a major hepatectomy and a total of 23 patients who underwent a PD.
  
  
  RESULTS
  The levels of vWF in the patients who underwent a major hepatectomy increased from before the operation to the seventh postoperative day and were significantly higher than those observed in the patients who underwent a PD. The ADAMTS13 activity in the patients who underwent a major hepatectomy gradually decreased throughout the first 14 postoperative days. In contrast, ADAMTS13 activity in the patients who underwent a PD returned to nearly normal levels within 2 weeks. Three patients who underwent a major hepatectomy had clinically significant thrombotic complications within the first 2 weeks after surgery; however, none of the patients who underwent a PD had thrombotic complications. The vWF to ADAMTS13 ratios of the 3 patients who experienced thrombotic complications were extremely high even before the occurrence of complications. No other procoagulant/fibrinolytic factors showed a marked association with thrombotic events. The vWF to ADAMTS13 ratio was significantly correlated with the estimated liver remnant volume (P < .001) but not with other preoperative or intraoperative factors.
  
  
  CONCLUSIONS
  The vWF to ADAMTS13 ratio may be a potentially useful marker in predicting thrombotic complications following a major hepatectomy.
authors.affiliation: Division of Surgical Oncology, Department of Surgery.
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsushita
authors.forename: Motoshi
authors.initials: M
authors.lastname: Kainuma
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D051722:ADAM Proteins / Q000097:blood*; D000071120:ADAMTS13 Protein; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013927:Thrombosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D014841:von Willebrand Factor / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014841:von Willebrand Factor; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human