Rotational thrombo elastometry and standard coagulation tests for hepatic patients undergoing major liver resection

Abstract

Background: Coagulopathy can associate right hepatotomy in cirrhotic patients. Methods: 20 cirrhotic patients were prospectively studied for 10 days with rotational thromboelastometry (ROTEM) and standard coagulation tests (SCTs). EXTEM and INTEM of ROTEM represent extrinsic and intrinsic coagulation pathways respectively. FIBTEM (ROTEM) represents fibrinogen activity. SCTS include Prothrombin time (PT), activated partial thromboplastin time (aPPT), fibrinogen and platelets. Results: Age and body mass index were 55.9 ± 6.9 years and 23.7 ± 3.1 Kg/m2. Males: Female (11:9). ROTEM parameters were normal except for a prolonged clotting time (CT) on day 1 and 3, associated with a normal clotting formation time (CFT). CT and PT were maximum on day 1 (86.25+15.7 mm and 17.2 ± 2.2 sec, p<0.05, respectively). CT and CFT (EXTEM) were not in correlation with PT (r=-0.29, r=-0.01, p>0.05 respectively). CT and CFT of (INTEM) were also not in correlation with aPTT (r=0.16, r=0.21, p>0.05 respectively). Fibrinogen correlated with maximum clot firmness (MCF) of FIBTEM (r=0.5, p<0.05). No correlation between Platetets count and MCF (EXTEM) or (INTEM) (-0.18, -0.22, p>0.05). Model of end stage liver disease (MELD) score correlated with preoperative CFT and MCF (EXTEM) (r=0.47, r=-0.48, p<0.05) respectively. Conclusion: Despite prolonged PT and CT, other ROTEM parameters reflected normal blood coagulation. ROTEM parameters correlated insignificantly with SCTs. MELD and ROTEM inter-relationship invites further studies. © 2012 Bedawy AA, et al.