Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

Abstract

Hepatectomy induced coagulation disturbances have been well studied over the past decade. Cumulative evidence supports the superiority of global coagulation analysis compared to conventional coagulation tests (i.e. PT or aPTT) for clinical decision making. Cancer, however, represents an acquired prothrombotic state and liver resection for cancer deserves a more thorough investigation. This prospective observational study was conducted to assess the perioperative coagulation status of patients undergoing major hepatectomies for primary or metastatic hepatic malignancy. Patients were followed up to the 10th postoperative day by serial measurements of conventional coagulation tests, plasma levels of coagulation factors and thrombin generation assay parameters. An abnormal coagulation profile was detected at presentation and included elevated FVIII levels, decreased levels of antithrombin and lag time prolongation in thrombin generation. Serial hematological data demonstrated increased vWF, FVIII, D-dimer, fibrinogen and decreased levels of natural anticoagulant proteins in the early postoperative period predisposing to a hypercoagulable state. The ratio of the anticoagulant protein C to the procoagulant FVIII was low at baseline and further declined postoperatively, indicating a prothrombotic state. Though no bleeding complications were reported, one patient experienced pulmonary embolism while under thromboprophylaxis. Overall, patients with hepatic carcinoma presenting for elective major hepatectomy may have baseline malignancy associated coagulation disturbances, aggravating the hypercoagulable state documented in the early postoperative period.

Hepatocellular carcinoma immune prognosis score predicts the clinical outcomes of hepatocellular carcinoma patients receiving immune checkpoint inhibitors

“…In addition, the nutritional status of HCC patients was less affected than other digestive cancers, making ALB more reflective of long-term liver damage. Since most components of the coagulation system were synthesized in the liver, the coagulation state of patients was also closely related to liver function [ 38 ]. Many studies have found that coagulation status could reflect the clinical outcomes of various cancers, and PT and TT were both prognostic indicators for HCC patients in this study [ 39 – 41 ].…”

A Laparoscopically Compatible Rapid‐Adhesion Bioadhesive for Asymmetric Adhesion, Non‐Pressing Hemostasis, and Seamless Seal

“…[39,40] However, this approach may not be suitable for all clinical scenarios, such as hemodynamically compromised procedures or operations with a risk of long-term complications. [41][42][43] Recently, minimally invasive surgery has been widely welcomed by patients because of its small trauma, light pain, and rapid recovery. [44,45] However, perioperative bleeding remains a thorny problem for minimally invasive surgery.…”

“…[ 39,40 ] However, this approach may not be suitable for all clinical scenarios, such as hemodynamically compromised procedures or operations with a risk of long‐term complications. [ 41–43 ]…”