title: Alterations in coagulation following major liver resection.
abstract: The international normalised ratio is frequently raised in patients who have undergone major liver resection, and is assumed to represent a potential bleeding risk. However, these patients have an increased risk of venous thromboembolic events, despite conventional coagulation tests indicating hypocoagulability. This prospective, observational study of patients undergoing major hepatic resection analysed the serial changes in coagulation in the early postoperative period. Thrombin generation parameters and viscoelastic tests of coagulation (thromboelastometry) remained within normal ranges throughout the study period. Levels of the procoagulant factors II, V, VII and X initially fell, but V and X returned to or exceeded normal range by postoperative day five. Levels of factor VIII and Von Willebrand factor were significantly elevated from postoperative day one (p < 0.01). Levels of the anticoagulants, protein C and antithrombin remained significantly depressed on postoperative day five (p = 0.01). Overall, the imbalance between pro- and anticoagulant factors suggested a prothrombotic environment in the early postoperative period.
authors.affiliation: Department of Anaesthesia, Royal Free Hospital, London, UK.
authors.forename: S V
authors.initials: SV
authors.lastname: Mallett
authors.affiliation: Department of Anaesthesia, Brighton and Sussex University Hospitals, Brighton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sugavanam
authors.affiliation: Department of Anaesthesia, Royal Free Hospital, London, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Krzanicki
authors.affiliation: Department of Anaesthesia, University College London Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Anaesthesia, Kings College Hospital, London, UK.
authors.forename: R H
authors.initials: RH
authors.lastname: Broomhead
authors.affiliation: University Department of Surgery, Royal Free Campus, University College London, London, UK.
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Riddell
authors.affiliation: University of Malta, Tal-Qroqq, Msida, Malta.
authors.forename: A
authors.initials: A
authors.lastname: Gatt
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Chowdary
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000032:analysis; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis; D013917:Thrombin / Q000096:biosynthesis
chemical_list: D001779:Blood Coagulation Factors; D011486:Protein C; D013917:Thrombin
keywords: coagulation factors; elevated INR; hepatic resection