Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous throthboembolism chemoprophylaxis
Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous throthboembolism chemoprophylaxis
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DOI：
10.1016/j.hpb.2016.10.012
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发表时间：
2017-02-01
期刊：
影响因子：
2.9
通讯作者：
Tzeng, Ching-Wei D.
中科院分区：
文献类型：
--
作者：
Anh-Thu Le;Harris, Jennifer W.;Tzeng, Ching-Wei D.
背景：我们假设肝-胰腺-胆道(HPB)手术患者更有可能是高凝状态而不是低凝状态，VTE化疗预防的出血风险较低。这项研究试图使用血栓弹性成像(TEG)来比较接受标准化围手术期化疗的HPB患者的凝血谱与出血/血栓事件的关系。方法：在一家机构(2014年1月至2015年12月)连续接受三名外科医生切除HPB的患者接受了术前和术后早期的VTE化学预防，并用TEGS进行了评估。结果：在87例患者中，83例(95.4%)术前接受了化学预防，术后100%接受了预防。中位数估计失血量为190毫升。只有2名患者(2.3%)接受了术中输血。72小时内无一例需要输血。仅2例在30天内输血。有1例(1.1%)发生30天的VTE事件。术前83例中29例(34.9%)为高凝状态，8例(9.6%)为低凝/纤溶状态。术后73例中34例(46.6%)为高凝状态，8例(11.0%)为低凝/纤溶状态。结论：在常规的围手术期化学预防措施下，静脉血栓栓塞术和出血事件均可忽略。围手术期TEG显示相当比例(46.6%)的HPB患者是高凝状态。HPB患者可以接受标准化的术前/术后早期VTE化疗预防，效果有效，对围手术期出血的担忧最小。
Background: We hypothesized hepato-pancreato-biliary (HPB) surgery patients are more likely to be hypercoagulable than hypocoagulable, and that bleeding risks from VTE chemoprophylaxis are low. This study sought to use thromboelastography (TEG) to compare coagulation profiles with bleeding/thrombotic events in HPB patients receiving standardized perioperative chemoprophylaxis.Methods: Consecutive patients undergoing HPB resections by three surgeons at one institution (January 2014-December 2015) received preoperative and early postoperative VTE chemoprophylaxis and were evaluated with TEGs. Coagulation profiles were compared to bleeding/thrombotic events.Results: Of 87 total patients, 83 (95.4%) received preoperative chemoprophylaxis and 100% received it postoperatively. Median estimated blood loss was 190 ml. Only 2 (2.3%) patients received intraoperative transfusions. None required transfusions at 72-hours. Only 2 were transfused within 30 days. There was 1 (1.1 %) 30-day VTE event. Of 83 preoperative TEGs, 29 (34.9%) were hypercoagulable and only 8 (9.6%) were hypocoagulable/fibrinolytic. Of 73 postoperative TEGs, 34 (46.6%) were hypercoagulable and just 8 (11.0%) were hypocoagulable/fibrinolytic.Conclusion: With routine perioperative chemoprophylaxis, both VTE and bleeding events were negligible. Perioperative TEG revealed a considerable proportion (46.6%) of HPB patients were hypercoagulable. HPB patients can receive standardized preoperative/early postoperative VTE chemoprophylaxis with effective results and minimal concern for perioperative hemorrhage.