Coagulological disorders during liver resections in patients with malignant tumors

Abstract

The purpose of the study. To study the coagulation profile of patients undergoing liver resections using laboratory tests and thromboelastography. Materials and methods. The results of observation of coagulological changes in 45 patients were studied: with colorectal liver metastases - 24 (53.3%) cases, with hepatocellular cancer - 14 (31.1%), with cholangiocellular cancer - 7 (15.6%). Right-sided hemihepatectomy was performed in 22 (48.9%) patients, right-sided extended hemihepatectomy - in 7 (15.6%), left-sided hemihepatectomy - in 8 (17.8%), resection of the left sector - in 8 (17.8%). Laboratory diagnostics included standard conventional coagulation tests and thromboelastography. Results. The concentrations of total bilirubin and alkaline phosphatase significantly increased up to 3 days of the postoperative period inclusive. The international normalized ratio increased significantly after liver resection immediately after surgery, as well as after 1, 3 and 5 days of observation. The level of fibrinogen in the first day after surgery decreases, and then increased to the initial value. Thromboelastometric parameters indicated a stable and normal coagulation function with a short ability to hypercoagulate immediately after liver resection. Conclusion. Although standard routine laboratory tests such as activated partial thromboplastin time and international normalized ratio may remain within normal limits or indicate hypocoagulation, the patient may be at risk for thrombosis. Thromboelastography measures the rate of formation, stabilization, and lysis of a clot using whole blood, which gives a more complete picture of coagulation status. Thus, routine laboratory parameters alone should not be used to decide whether to delay thromboembolic prophylaxis after liver resection.