title: The temporal pattern of postoperative coagulation status in patients undergoing major liver surgery.
abstract: BACKGROUND
  After major liver surgery, there are risks of both postoperative bleeding and thrombosis. Routine coagulation monitoring is indicated, but may not provide adequate clinical guidance. Thus, we described the clotting status in a pilot study using broader coagulation testing. We analysed the temporal pattern of coagulation tests to assess whether thromboelastometry (ROTEM®) would improve the quality of the postoperative monitoring of the coagulation status in patients undergoing major hepatic resections.
  
  
  METHODS
  Sixteen patients undergoing major liver resections were examined prior to surgery, on postoperative day 1, and subsequently, every three postoperative days during hospitalization. At the same time, the clinical signs of bleeding and thrombotic complications were monitored.
  
  
  RESULTS
  On postoperative day 1, increases in bilirubin, PT-INR, APTT, and D-dimers were observed, together with concomitant decreases in fibrinogen, platelet count, antithrombin (AT), protein C and protein S compared to preoperative values. On postoperative days 4 and 7, all of the variables had returned to the normal range except for D-dimers, AT and protein C. The ROTEM® median values remained within the normal range. There were no significant episodes of postoperative bleeding. Two patients were diagnosed with a pulmonary embolism.
  
  
  CONCLUSIONS
  Despite the abnormalities observed in routine coagulation monitoring, thromboelastometry indicated a balanced coagulation status following major hepatic surgery. The levels of both pro- and anticoagulant proteins changed over time during this period. The exact clinical role for thromboelastometry in major hepatic surgery remains to be established.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. Electronic address: gabriel.dumitrescu@karolinska.se.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Dumitrescu
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Januszkiewicz
authors.affiliation: Department of Medicine, Division of Haematology, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Ågren
authors.affiliation: CLINTEC, Division of Paediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Magnusson
authors.affiliation: CLINTEC, Division of Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Isaksson
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D011184:Postoperative Period; D018570:Risk Assessment; D013916:Thrombelastography; D013927:Thrombosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
keywords: Blood coagulation; Hemihepatectomy; ROTEM; Thromboelastometry; Thromboembolism