Persistence of Hypercoagulable State after Resection of Intra-Abdominal Malignancies

Malignancy does not dictate the hypercoagulable state following liver resection

“…8,9 There have been differences that have been discovered in comparing patients' postoperative TEG values over time and also comparing pre-and postoperative values. However, these studies had heterogeneous disease processes with regards to the origin of malignancy.…”

“…The previous studies combined different abdominal organ systems (eg, pancreatic, gastric, hepatic, esophageal, small bowel, etc) for a total patient population of 35 to 56 patients. 8,9 Furthermore, the number of patients with only hepatobiliary disease never exceeded 38 patients and the authors did not compare patients with benign or malignant disease. Considering that our study has double the number of patients compared with previous studies with liver or biliary disease and still has the challenge of effectively powering a study speaks to the difficulty of this field of study and the contribution of this work within it.…”

“…Previous studies have shown that a postoperative hypercoagulable state persists after resection of abdominal malignancies. 8,9 However, none of these patients had benign disease. This raises the question of whether the hypercoagulable state following resection is because of the postoperative state or hypercoagulability associated with malignancy.…”

A reply

“…Firstly, did they consider excluding patients with poor dentition, as this can complicate i-gel insertion? Secondly, why was a peak airway pressure of 10 cmH 2 O used for testing airway leaks, when a value of 20 cmH 2 O is more commonly used [2]? Thirdly, how many manipulations were attempted before the first attempt was determined to have been a failure?…”

“…Hypercoagulability can be detected with rotational thromboelastography (ROTEM â ) as shortened clotting time (CT) and clot firmness time (CFT) and/or increased alpha angle and maximum clot firmness (MCF). Thorson et al [2] specified hypercoagulability as any ROTEM variable (CT, CFT, MCF in INTEM or EXTEM, or MCF of FIBTEM) lying outside the reference range. However, universal diagnostic criteria of hypercoagulation in ROTEM are still not defined.…”