Risk factors for coagulopathy after liver resection.

Abstract

STUDY OBJECTIVE:

To identify risk factors for coagulopathy in patients undergoing liver resection.

DESIGN:

A retrospective cohort study.

SETTING:

Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery.

PATIENTS:

One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7).

MEASUREMENTS:

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.

MAIN 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: Tina Ramspoth, Anna B Roehl, Stephan Macko, Cristoph Heidenhain, Karsten Junge, Marcel Binnebösel, Maximilian Schmeding, Ulf P Neumann, Rolf Rossaint, Marc Hein
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 26 Issue 8 Pg. 654-62 (Dec 2014) ISSN: 1873-4529 [Electronic] United States
• PMID: 25468574 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Aged
• Anesthesia, Epidural (methods)
• Blood Coagulation Disorders (epidemiology, etiology)
• Cohort Studies
• Hepatectomy (methods)
• Hospitals, University
• Humans
• International Normalized Ratio
• Liver Diseases (surgery)
• Middle Aged
• Partial Thromboplastin Time
• Platelet Count
• Retrospective Studies
• Risk Factors