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Perioperative monitoring of coagulation in patients after abdominal surgery

Introduction

Despite the evidence of perioperative hypercoagulability in cancer patients, there are no consistent data evaluating the extent, duration, and specific contribution of platelets and procoagulatory proteins by in vitro testing. This study compared the efficacy of haemoviscoelastography (HVG) versus thromboelastography (TEG) for monitoring coagulation imbalance.

Methods

In 108 patients undergoing surgery for abdominal cancer we examined the efficacy of a variety of coagulation tests. A complete coagulation screening, TEG and HVG were performed before and at the end of surgery.

Results

We calculated the elastic shear modulus of standard maximum amplitude (MA) (Gt) and HVG MA (Gh), which reflect the total clot strength and procoagulatory protein component, respectively. The difference was an estimate of the platelet component (Gp). There was a 14% perioperative increase of standard MA, corresponding to a 48% increase of Gt (<0.05/J) and an 80–86% contribution of the calculated Gp to Gt. We conclude that serial standard TEG and HVG viscoelastic tests may reveal the independent contribution of platelets and procoagulatory proteins to clot strength. The results showed that some components of the TEG failed to identify hypercoagulation (r < 0.2, P > 0.75). All components of the HVG test reflected postoperative coagulopathies.

Conclusion

Hypercoagulability is not reflected completely by standard coagulation monitoring and TEG, and seems to be predominantly caused by increased platelet reactivity. HVG provides a fast and easy-to-perform bedside test to quantify in vitro coagulation, and may be useful in determining the coagulation status of cancer patients perioperatively.

References

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Tarabrin, O., Mazur, V., Suhanov, A. et al. Perioperative monitoring of coagulation in patients after abdominal surgery. Crit Care 12, P217 (2008). https://doi.org/10.1186/cc6438

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Keywords

  • Platelet Reactivity
  • Elastic Shear Modulus
  • Clot Strength
  • Coagulation Monitoring
  • Complete Coagulation