Rotational thromboelametry and standard coagulation tests

Rotational thromboelametry and standard coagulation tests

Rotational thromboelametry and standard coagulation tests for hepatic patients undergoing major liver resection.
K Yassen MD FFARCSI Professor of Anaesthesia Liver Institute, Menoufiya University, Egypt. kyassen61@hotmail.com Perioperative coagulopathy • Removal of a considerable hepatic mass during right hepatotomy could reduce the hepatic synthesis of clotting factors resulting in a hypocoagulable state or hypercoagulable • Few studies were designed to investigate coagulation changes in cirrhotic patients undergoing major liver surgery as right hepatotomy. Patients and Methods • 20 cirrhotic patients (CHILD A) were prospectively studied for 10 days. • Rotational thromboelastometry (ROTEM): EXTEM and INTEM of ROTEM represent extrinsic and intrinsic coagulation pathways respectively. FIBTEM (ROTEM) represents fibrinogen activity. • Standard coagulation tests: Prothrombin time (PT), activated partial thromboplastin time (aPPT), fibrinogen and platelets. Demographic Data •
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Age: 55.9 ± 6.9 years Body mass index (BMI): 23.7 + 3.1 Kg/m2. Males: Female (11:9). Right hepatotomy Additional parameters possible
ROTEM 4 channel monitoring Hypothermia & DVT Prevention • Forced warm air devices used with upper and lower blankets • Repeated sequential muscle massage device and elastic stockings perioperatively • Factor V lieden Mutation and other coagulation studies. 1 cases cancelled for homozygote trait.
Prothrombin Time
Activated partial thromboplastin time (aPTT)
Fibrinogen mg/dl
Platelets /mm3
Liver Institute ‐ Menoufiya University OR
Clotting Time of EXTEM
Clot Firmness Time of EXTEM
Maximum Clot Firmness of EXTEM
Clotting time of INTEM
Clot Firmness Time of INTEM
Maximum Clot Firmness of INTEM
Correlation between Fibrinogen and MCF INTEM
Correlation between Fibrinogen and MCF INTEM
Correlation between platelets and MCF‐INTEM
PT correlation with ROTEM (INTEM‐CFT)
PT correlation with ROTEM (EXTEM‐CFT)
INR correlation with ROTEM (INTEM‐CFT)
INR correlation with ROTEM (EXTEM‐CFT)
Conclusion • Despite prolonged PT and CT, other ROTEM parameters reflected normal coagulation. • Anticoagulation regimes in hepatic patients
undergoing liver surgery should be encouraged
with ROTEM monitoring. • ROTEM correlated insignificantly with SCTs. • MELD and ROTEM inter‐relationship invites further studies. Alexandria – Menoufiya Universities Scientific Link • Anesthesia & Clinical Research Journal 2012 • Rotational Thrombo Elastometry and Standard Coagulation Tests for Hepatic Patients undergoing Major Liver Resection • Ahmed A Bedawy2, Nirmeen A Fayed1, Wesam Morad3, Said Madany2, Fawzy Nematalah2 and Khaled A Yassen1* • 1Department of Anaesthesia, Liver Institute, MENOUFIYA UNIVERSITY • 2Department of Anaesthesia, ALEXANDRIA UNIVERSITY. • 3Department of Community Health, Liver Institute, Menoufiya University. Paris
• 'Postoperative pain control in view of the coagulation profile changes in cirrhotic patients undergoing liver resection' 'A‐432‐
0008‐00570' has been accepted for a poster presentation
Publication in process at Journal Anesth and Clin Res 2012, 3:9 • Accepted for Publication • Authors: • Ahmed A Bedawy, Nirmeen A Fayed, Wessam Mourad , Said Madany , Fawzy Nematalah, Khaled Yassen. • Open Access • Research Article • ISSN:2155‐6148 JACR an open access journal • Volume 3 • Issue 9 • 1000243 New Liver Institute
Menoufiya University Egypt
Dean Magdy Khalil Prof. Khaled AboElla Surgeon
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