title: Risk factors for coagulopathy after liver resection.
abstract: OBJECTIVE
  To identify risk factors for coagulopathy in patients undergoing liver resection.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery.
  
  
  METHODS
  One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7).
  
  
  METHODS
  Coagulopathy was defined as 1 or more of the following events: international normalized ratio ≥1.4, platelet count <80,000/μL, and partial thromboplastin time >38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy.
  
  
  RESULTS
  Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio (P = .001), postoperative peak lactate levels (P = .012), and resected liver weight (P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy.
  
  
  CONCLUSIONS
  Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (≥3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided.
authors.affiliation: Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Ramspoth
authors.affiliation: Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Roehl
authors.affiliation: Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Macko
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Cristoph
authors.initials: C
authors.lastname: Heidenhain
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Junge
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmeding
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.affiliation: Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany. Electronic address: mhein@ukaachen.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Hein
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D001778:Blood Coagulation Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D006498:Hepatectomy / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D019934:International Normalized Ratio; D008107:Liver Diseases / Q000601:surgery*; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Coagulopathy; Epidural anesthesia; Liver resection; Risk factors