THROMBELASTOGRAPHIC EVALUATION OF COAGULATION IN TRANSURETHRAL PROSTATECTOMY

Objective To assess the changes in overall coagulation status and defi ne the degree of systemic fibrinolysis occurring in patients undergoin g transurethral prostatectomy (TURF). Patients and methods Thirty pati ents undergoing TURF, 23 for benign prostatic hyperplasia and seven fo r prostatic carcinoma, were studied prospectively. Serial venous blood samples were taken using the two-syringe technique. Samples were take n before, during and at internals up to 72 h and 10-14 days after surg ery. Thrombelastography (TEG) was performed on native whole blood samp les. Peri-operative blood loss was assessed, until the catheter was re moved, by photometric estimation of the haemoglobin content of the irr igant fluid and the measurement of clot volume. Results There was no e vidence of fibrinolysis (TEG Percentage Clot Lysis Ly(60) > 15%) in an y patient oner the whole peri-operative period. There was a significan t change in the mean TEG variables towards hypercoagulation from 3 h u ntil. 10-14 days postoperatively, compared with the pre-operative valu es (P < 0.05). There was a significant correlation between blood loss and clot volume. Conclusion These results question the role of systemi c fibrinolysis in primary and secondary haemorrhage following TURF and thus the rationale of using antifibrinolytics in these patients. The persistent hypercoagulable state post-operatively indicates a possible role of hypercoagulability in clot retention.