Risk factors for coagulopathy after liver resection
Abstract Study Objective To identify risk factors for coagulopathy in patients undergoing liver resection. Design A retrospective cohort study. Setting Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. Pati...
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| Veröffentlicht in: | Journal of clinical anesthesia 2014-12, Vol.26 (8), p.654-662 |
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| creator | Ramspoth, Tina, MD Roehl, Anna B., MD Macko, Stephan, MD Heidenhain, Cristoph, MD Junge, Karsten, MD Binnebösel, Marcel, MD Schmeding, Maximilian, MD Neumann, Ulf P., MD Rossaint, Rolf, MD Hein, Marc, MD |
| description | Abstract Study Objective To identify risk factors for coagulopathy in patients undergoing liver resection. Design A retrospective cohort study. Setting Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. Patients One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7). Measurements Coagulopathy was defined as 1 or more of the following events: international normalized ratio ≥ 1.4, platelet count < 80,000/μL, and partial thromboplastin time > 38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy. Main Results Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio ( P = .001), postoperative peak lactate levels ( P = .012), and resected liver weight ( P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy. Conclusions Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (≥ 3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided. |
| doi_str_mv | 10.1016/j.jclinane.2014.08.002 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1827910375</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0952818014003122</els_id><sourcerecordid>1637562823</sourcerecordid><originalsourceid>FETCH-LOGICAL-c484t-51dc91bd9aa9ac0653d157841d8aec330f4f428e123f2e0da15a2772dfee58313</originalsourceid><addsrcrecordid>eNqFkk9v1DAQxS1ERbeFr1BF4sIlYcZ_EueCQFWhSJUq0XK2XGcCTrPxYieV9tvjaFuQeunFPvg3z3rvDWNnCBUC1h-HanCjn-xEFQeUFegKgL9iG9SNKKXi7Wu2gVbxUqOGY3aS0gAA-QHfsGOuZK1VIzdM_PDpvuitm0NMRR9i4YL9tYxhZ-ff-8L2M8Vi9A_5jJTIzT5Mb9lRb8dE7x7vU_bz68Xt-WV5df3t-_mXq9JJLedSYedavOtaa1vroFaiQ9VoiZ225ISAXvaSa0Iuek7QWVSWNw3veiKlBYpT9uGgu4vhz0JpNlufHI1jdh2WZFDzpkUQjXoZrTNVc81FRt8_Q4ewxCkbWSmp61boNlP1gXIxpBSpN7votzbuDYJZGzCDeWrArA0Y0CY3kAfPHuWXuy11_8aeIs_A5wNAOboHT9Ek52ly1PmY8zVd8C__8emZxEp5Z8d72lP678ckbsDcrHuwrgFKAIGci7_eOK1f</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1634869389</pqid></control><display><type>article</type><title>Risk factors for coagulopathy after liver resection</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Ramspoth, Tina, MD ; Roehl, Anna B., MD ; Macko, Stephan, MD ; Heidenhain, Cristoph, MD ; Junge, Karsten, MD ; Binnebösel, Marcel, MD ; Schmeding, Maximilian, MD ; Neumann, Ulf P., MD ; Rossaint, Rolf, MD ; Hein, Marc, MD</creator><creatorcontrib>Ramspoth, Tina, MD ; Roehl, Anna B., MD ; Macko, Stephan, MD ; Heidenhain, Cristoph, MD ; Junge, Karsten, MD ; Binnebösel, Marcel, MD ; Schmeding, Maximilian, MD ; Neumann, Ulf P., MD ; Rossaint, Rolf, MD ; Hein, Marc, MD</creatorcontrib><description>Abstract Study Objective To identify risk factors for coagulopathy in patients undergoing liver resection. Design A retrospective cohort study. Setting Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. Patients One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7). Measurements Coagulopathy was defined as 1 or more of the following events: international normalized ratio ≥ 1.4, platelet count < 80,000/μL, and partial thromboplastin time > 38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy. Main Results Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio ( P = .001), postoperative peak lactate levels ( P = .012), and resected liver weight ( P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy. Conclusions Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (≥ 3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2014.08.002</identifier><identifier>PMID: 25468574</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Anesthesia ; Anesthesia & Perioperative Care ; Anesthesia, Epidural - methods ; Blood Coagulation Disorders - epidemiology ; Blood Coagulation Disorders - etiology ; Blood platelets ; Coagulopathy ; Cohort Studies ; Confidence intervals ; Epidural anesthesia ; Hepatectomy - methods ; Hospitals ; Hospitals, University ; Humans ; International Normalized Ratio ; Laboratories ; Liver Diseases - surgery ; Liver resection ; Middle Aged ; Mortality ; Pain Medicine ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Risk Factors ; Studies ; Surgery</subject><ispartof>Journal of clinical anesthesia, 2014-12, Vol.26 (8), p.654-662</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-51dc91bd9aa9ac0653d157841d8aec330f4f428e123f2e0da15a2772dfee58313</citedby><cites>FETCH-LOGICAL-c484t-51dc91bd9aa9ac0653d157841d8aec330f4f428e123f2e0da15a2772dfee58313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1634869389?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25468574$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramspoth, Tina, MD</creatorcontrib><creatorcontrib>Roehl, Anna B., MD</creatorcontrib><creatorcontrib>Macko, Stephan, MD</creatorcontrib><creatorcontrib>Heidenhain, Cristoph, MD</creatorcontrib><creatorcontrib>Junge, Karsten, MD</creatorcontrib><creatorcontrib>Binnebösel, Marcel, MD</creatorcontrib><creatorcontrib>Schmeding, Maximilian, MD</creatorcontrib><creatorcontrib>Neumann, Ulf P., MD</creatorcontrib><creatorcontrib>Rossaint, Rolf, MD</creatorcontrib><creatorcontrib>Hein, Marc, MD</creatorcontrib><title>Risk factors for coagulopathy after liver resection</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Abstract Study Objective To identify risk factors for coagulopathy in patients undergoing liver resection. Design A retrospective cohort study. Setting Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. Patients One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7). Measurements Coagulopathy was defined as 1 or more of the following events: international normalized ratio ≥ 1.4, platelet count < 80,000/μL, and partial thromboplastin time > 38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy. Main Results Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio ( P = .001), postoperative peak lactate levels ( P = .012), and resected liver weight ( P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy. Conclusions Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (≥ 3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided.</description><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia & Perioperative Care</subject><subject>Anesthesia, Epidural - methods</subject><subject>Blood Coagulation Disorders - epidemiology</subject><subject>Blood Coagulation Disorders - etiology</subject><subject>Blood platelets</subject><subject>Coagulopathy</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Epidural anesthesia</subject><subject>Hepatectomy - methods</subject><subject>Hospitals</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Laboratories</subject><subject>Liver Diseases - surgery</subject><subject>Liver resection</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pain Medicine</subject><subject>Partial Thromboplastin Time</subject><subject>Platelet Count</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Surgery</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkk9v1DAQxS1ERbeFr1BF4sIlYcZ_EueCQFWhSJUq0XK2XGcCTrPxYieV9tvjaFuQeunFPvg3z3rvDWNnCBUC1h-HanCjn-xEFQeUFegKgL9iG9SNKKXi7Wu2gVbxUqOGY3aS0gAA-QHfsGOuZK1VIzdM_PDpvuitm0NMRR9i4YL9tYxhZ-ff-8L2M8Vi9A_5jJTIzT5Mb9lRb8dE7x7vU_bz68Xt-WV5df3t-_mXq9JJLedSYedavOtaa1vroFaiQ9VoiZ225ISAXvaSa0Iuek7QWVSWNw3veiKlBYpT9uGgu4vhz0JpNlufHI1jdh2WZFDzpkUQjXoZrTNVc81FRt8_Q4ewxCkbWSmp61boNlP1gXIxpBSpN7votzbuDYJZGzCDeWrArA0Y0CY3kAfPHuWXuy11_8aeIs_A5wNAOboHT9Ek52ly1PmY8zVd8C__8emZxEp5Z8d72lP678ckbsDcrHuwrgFKAIGci7_eOK1f</recordid><startdate>20141201</startdate><enddate>20141201</enddate><creator>Ramspoth, Tina, MD</creator><creator>Roehl, Anna B., MD</creator><creator>Macko, Stephan, MD</creator><creator>Heidenhain, Cristoph, MD</creator><creator>Junge, Karsten, MD</creator><creator>Binnebösel, Marcel, MD</creator><creator>Schmeding, Maximilian, MD</creator><creator>Neumann, Ulf P., MD</creator><creator>Rossaint, Rolf, MD</creator><creator>Hein, Marc, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>7U7</scope><scope>C1K</scope></search><sort><creationdate>20141201</creationdate><title>Risk factors for coagulopathy after liver resection</title><author>Ramspoth, Tina, MD ; Roehl, Anna B., MD ; Macko, Stephan, MD ; Heidenhain, Cristoph, MD ; Junge, Karsten, MD ; Binnebösel, Marcel, MD ; Schmeding, Maximilian, MD ; Neumann, Ulf P., MD ; Rossaint, Rolf, MD ; Hein, Marc, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-51dc91bd9aa9ac0653d157841d8aec330f4f428e123f2e0da15a2772dfee58313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia & Perioperative Care</topic><topic>Anesthesia, Epidural - methods</topic><topic>Blood Coagulation Disorders - epidemiology</topic><topic>Blood Coagulation Disorders - etiology</topic><topic>Blood platelets</topic><topic>Coagulopathy</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Epidural anesthesia</topic><topic>Hepatectomy - methods</topic><topic>Hospitals</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Laboratories</topic><topic>Liver Diseases - surgery</topic><topic>Liver resection</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pain Medicine</topic><topic>Partial Thromboplastin Time</topic><topic>Platelet Count</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramspoth, Tina, MD</creatorcontrib><creatorcontrib>Roehl, Anna B., MD</creatorcontrib><creatorcontrib>Macko, Stephan, MD</creatorcontrib><creatorcontrib>Heidenhain, Cristoph, MD</creatorcontrib><creatorcontrib>Junge, Karsten, MD</creatorcontrib><creatorcontrib>Binnebösel, Marcel, MD</creatorcontrib><creatorcontrib>Schmeding, Maximilian, MD</creatorcontrib><creatorcontrib>Neumann, Ulf P., MD</creatorcontrib><creatorcontrib>Rossaint, Rolf, MD</creatorcontrib><creatorcontrib>Hein, Marc, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramspoth, Tina, MD</au><au>Roehl, Anna B., MD</au><au>Macko, Stephan, MD</au><au>Heidenhain, Cristoph, MD</au><au>Junge, Karsten, MD</au><au>Binnebösel, Marcel, MD</au><au>Schmeding, Maximilian, MD</au><au>Neumann, Ulf P., MD</au><au>Rossaint, Rolf, MD</au><au>Hein, Marc, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for coagulopathy after liver resection</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2014-12-01</date><risdate>2014</risdate><volume>26</volume><issue>8</issue><spage>654</spage><epage>662</epage><pages>654-662</pages><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>Abstract Study Objective To identify risk factors for coagulopathy in patients undergoing liver resection. Design A retrospective cohort study. Setting Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. Patients One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7). Measurements Coagulopathy was defined as 1 or more of the following events: international normalized ratio ≥ 1.4, platelet count < 80,000/μL, and partial thromboplastin time > 38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy. Main Results Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio ( P = .001), postoperative peak lactate levels ( P = .012), and resected liver weight ( P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy. Conclusions Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (≥ 3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25468574</pmid><doi>10.1016/j.jclinane.2014.08.002</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Anesthesia Anesthesia & Perioperative Care Anesthesia, Epidural - methods Blood Coagulation Disorders - epidemiology Blood Coagulation Disorders - etiology Blood platelets Coagulopathy Cohort Studies Confidence intervals Epidural anesthesia Hepatectomy - methods Hospitals Hospitals, University Humans International Normalized Ratio Laboratories Liver Diseases - surgery Liver resection Middle Aged Mortality Pain Medicine Partial Thromboplastin Time Platelet Count Retrospective Studies Risk Factors Studies Surgery |
| title | Risk factors for coagulopathy after liver resection |
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