Coagulopathy following major liver resection: The effect of rBPI(21) and the role of decreased synthesis of regulating proteins by the liver

This prospective study investigated the role of reduced hepatic synthesis o f regulating proteins in coagulopathy after partial hepatectomy (PH) compar ed with major abdominal surgery (MAS) without involvement of the liver. Fur thermore, we studied the effect of rBPI(21), an endotoxin-neutralizing agen t, on coagulopathy after PH was studied. Compared with MAS, PH resulted in significantly elevated levels of thrombin-antithrombin-lll and plasmin-alph a2-antiplasmin complexes. Levels of antithrombin-3, alpha2-antiplasmin, fib rinogen, plasminogen, alpha2-macroglobulin (alpha2-M), and C1-inhibitor rem ained lower following PH. Treatment with rBPI(21) led to significantly lowe r levels of tissue-type plasminogen activator (t-PA). Post-operative dissem inated intravascular coagulation (DIC) was associated with significantly hi gher bilirubin and t-PA plasma levels and significantly lower levels of alp ha2-M. This study indicates that PH induced hepatic failure results in decr eased synthesis of hepatic regulating plasma proteins and subsequent activa tion of coagulation and fibrinolysis. Prevention of t-PA release by rBPI(21 ) may have important clinical implications. Decreased availability of alpha 2-M may be a factor in post-operative DIG.