Blood Coagulatory Disturbance in Perioperative with Obstructive Jaundice

To determine the relationship between blood coagulatory disturbance and obstructive jaundice, we studied the hypercoagulable state in 12 patients with obstructive jaundice due to pancreas head cancer, common bile duct cancer or chronic pancreatitis who had undergone radical resection after choledochal drainage. Before the choledochal drainage, the hypercoagulability was higher in patients with more than 20 mg of total bilirubin (TB) per dl than in patients with less than 20 mg/dl. After the choledochal drainage, the hypercoagulabe state disappeared, while a low level of antithrombin III (AT III), slight platelet aggregation and fibrinolytic activity remained. The hypercoagulability increased markedly again immediately after the operation and a correlation between hemorrhage and the rate of decrease in platelet count (PLT) was noted. A marked decrease in PLT and/or AT III immediately after the operation often warned of multiple organ failure and/or insufficiency of anastomosis. The postoperative hypercoagulable state was reversed within a week in uneventful cases, while it was delayed in cases complicated by multiple organ failure and/or insufficiency of anastomosis.