Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous thromboembolism chemoprophylaxis

HPB (Oxford). 2017 Feb;19(2):154-161. doi: 10.1016/j.hpb.2016.10.012. Epub 2016 Nov 25.

Abstract

Background: We hypothesized hepato-pancreato-biliary (HPB) surgery patients are more likely to be hypercoagulable than hypocoagulable, and that bleeding risks from VTE chemoprophylaxis are low. This study sought to use thromboelastography (TEG) to compare coagulation profiles with bleeding/thrombotic events in HPB patients receiving standardized perioperative chemoprophylaxis.

Methods: Consecutive patients undergoing HPB resections by three surgeons at one institution (January 2014-December 2015) received preoperative and early postoperative VTE chemoprophylaxis and were evaluated with TEGs. Coagulation profiles were compared to bleeding/thrombotic events.

Results: Of 87 total patients, 83 (95.4%) received preoperative chemoprophylaxis and 100% received it postoperatively. Median estimated blood loss was 190 ml. Only 2 (2.3%) patients received intraoperative transfusions. None required transfusions at 72-hours. Only 2 were transfused within 30 days. There was 1 (1.1%) 30-day VTE event. Of 83 preoperative TEGs, 29 (34.9%) were hypercoagulable and only 8 (9.6%) were hypocoagulable/fibrinolytic. Of 73 postoperative TEGs, 34 (46.6%) were hypercoagulable and just 8 (11.0%) were hypocoagulable/fibrinolytic. .

Conclusion: With routine perioperative chemoprophylaxis, both VTE and bleeding events were negligible. Perioperative TEG revealed a considerable proportion (46.6%) of HPB patients were hypercoagulable. HPB patients can receive standardized preoperative/early postoperative VTE chemoprophylaxis with effective results and minimal concern for perioperative hemorrhage.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Blood Coagulation / drug effects*
  • Blood Loss, Surgical / prevention & control
  • Blood Transfusion
  • Digestive System Surgical Procedures / adverse effects*
  • Drug Administration Schedule
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Kentucky
  • Male
  • Middle Aged
  • Perioperative Care
  • Postoperative Hemorrhage / chemically induced
  • Postoperative Hemorrhage / diagnosis
  • Postoperative Hemorrhage / prevention & control
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Thrombelastography*
  • Thrombophilia / blood
  • Thrombophilia / complications
  • Thrombophilia / diagnosis
  • Thrombophilia / drug therapy*
  • Time Factors
  • Treatment Outcome
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*

Substances

  • Fibrinolytic Agents