Changes in haemostasis during liver resections

Objectives: To assess changes in haemostasis during liver resection and to discuss the indications for antifibrinolytic therapy. Study design: Open prospective study Patients: The study included 39 consecutive non-cirrhotic patients presenti ng for liver resection under portal triad clamping. Method: General anaesthesia was obtained with thiopentone, fentanyl, vecuro nium and isoflurane. Transfusion scheme was standardized. Aprotinin (5,000 kIU.kg(-1) BW) was administered in case of unexplained bleeding in the oper ative field. Coagulation pattern was assessed by routine tests and thrombel astrography before surgery, before portal triad clamping, 5 min after reper fusion and at completion of surgery. Patients requiring aprotinin intraoper atively were compared to others. Results: In 32 patients no significant bleeding occurred. Their coagulation pattern was moderately changed and remained within the normal range. In se ven patients severe bleeding occurred which was treated with aprotinin. The ir coagulation tests were significantly modified, especially after reperfus ion, associating an increase in aPTT, TT, FDP, DDim, r + k and a decreased platelet count. Conclusion: These changes were more in favour of a dilution coagulopathy or a DIC than hyperfibrinolysis. Therefore substitutive therapy with coagulati on factors should be preferred to an antifibrinolytic agent. A systematic a dministration of the latter for liver resection in non-cirrhotic patients i s debatable, considering the allergic risk (reoperation for cancer recurren ce), thrombosis facilitation (pedicle clamping) and high cost. (C) 1999 Els evier, Paris.