The international normalized ratio overestimates coagulopathy in patients after major hepatectomy
The international normalized ratio overestimates coagulopathy in patients after major hepatectomy
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DOI：
10.1016/j.amjsurg.2013.12.021
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发表时间：
2014-05-01
影响因子：
3
通讯作者：
Billingsley, Kevin G.
中科院分区：
文献类型：
--
作者：
Louis, Scott G.;Barton, Jeffrey S.;Billingsley, Kevin G.
背景：国际标准化比值（INR）通常用于指导肝切除术后的治疗。我们假设，血栓弹力图（TEG）的使用将证明在此患者population.METHODS的低凝状态的发病率降低：78例患者进行肝切除术前前瞻性招募。分别于术前、术后、术后第1、3、5天测定INR、TEG和凝血因子。然而，TEG显示术后R值降低，随后恢复正常。其他TEG测量值与术前值相当。所有促凝血因子保存因子VIII术后下降，同时减少蛋白C。结论：TEG表现出短暂的高凝状态后，肝切除术，随后正常化与凝血。国际标准化比值明显高估了肝切除术后的低凝状态，这些数据对目前使用国际标准化比值指导该患者人群治疗的做法提出了质疑。(C)2014爱思唯尔公司All rights reserved.
BACKGROUND: The International Normalized Ratio (INR) is commonly used to guide therapy after hepatectomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a decreased incidence of hypocoagulability in this patient population.METHODS: Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5.RESULTS: Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C.CONCLUSIONS: TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population. (C) 2014 Elsevier Inc. All rights reserved.