PB0973 - Perioperative Coagulation Profile in Major Liver Resection for Cancer

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

EL

Elmina Lefkou

PhD
Research Group "Cancer - Hemostasis - Angiogenesis" Thrombosis Center
Paris, Ile-de-France, France
PT

Petros Tzimas

anesthetist
Departement of anaesthesia and postoperative intensive care Ioannina
loannina, Attiki, Greece

Presenting Author(s)

Patrick Van Dreden, PhD

PhD clinical research manager
Clinical Research Department, Diagnostica Stago
Gennevilliers, Ile-de-France, France

Co-Author(s)

AK

Agathi Karakosta

anesthetist
Departement of anaesthesia and postoperative intensive care Ioannina
Ioannina, Attiki, Greece
EP

Evangelia Papapetrou

biologist
University Hospital of Ioannina
Ioannina, Attiki, Greece
DP

Despoina Pantazi

biologist
University Hospital of Ioannina
Ioannina, Attiki, Greece
PS

Panagiota Stratigopoulou

anesthetist
Departement of anaesthesia and postoperative intensive care Ioannina
Ioannina, Attiki, Greece
Grigorios Gerotziafas

Pr
Research Group "Cancer - Hemostasis - Angiogenesis" Thrombosis Center
Paris, Ile-de-France, France

Background: Hepatectomy-induced coagulation disturbances have been well studied over the past decade. Cumulative evidence supports the superiority of global coagulation analysis compared with conventional coagulation tests (i.e., prothrombin time or activated partial thromboplastin time) for clinical decision making. Cancer, however, represents an acquired prothrombotic state and liver resection for cancer deserves a more thorough investigation.

Aims: This prospective observational study was conducted to assess the perioperative coagulation status of patients undergoing major hepatectomies for primary or metastatic hepatic malignancy.

Methods: Patients were followed up to the 10th post-operative day by serial measurements of conventional coagulation tests, plasma levels of coagulation factors, and thrombin generation (TF 5 pM PPP-Reagent on Calibrated Automated Thrombogram: Stago, France) assay parameters.

Results: 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 Von Willebrand factor, FVIII, D-dimer, fibrinogen and decreased levels of natural anticoagulant proteins in the early post-operative period predisposing to a hyper-coagulable state. The ratio of the anticoagulant protein C to the procoagulant FVIII was low at baseline and further declined post-operatively, indicating a prothrombotic state (Table 1 and 2).

Conclusion(s): This study shows that patients with hepatic malignancy have systematic endothelial activation and hypercoagulability. These patients are in a hypercoagulable state in the early post-operative period. Measurements of INR, PT, aPTT are not useful in this setting and could be misleading. Global coagulation analysis may be more appropriate for clinical guidance. To the best of our knowledge this is the first report in literature documenting the preexisting coagulation disturbances in patients with hepatic carcinoma and their impact on the coagulation status after major hepatectomy. However, the clinical implications of our findings deserve further investigation.