Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous thromboembolism chemoprophylaxis

Anh Thu Le, Jennifer W. Harris, Erin Maynard, Sean P. Dineen, Ching Wei D Tzeng

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)154-161
Number of pages8
JournalHPB
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Thrombelastography
Thrombophilia
Venous Thromboembolism
Chemoprevention
Hemorrhage

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous thromboembolism chemoprophylaxis. / Le, Anh Thu; Harris, Jennifer W.; Maynard, Erin; Dineen, Sean P.; Tzeng, Ching Wei D.

In: HPB, Vol. 19, No. 2, 01.02.2017, p. 154-161.

Research output: Contribution to journalArticle

@article{7ccb029988b043bcadae81f9b2186c4e,
title = "Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous thromboembolism chemoprophylaxis",
abstract = "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.",
author = "Le, {Anh Thu} and Harris, {Jennifer W.} and Erin Maynard and Dineen, {Sean P.} and Tzeng, {Ching Wei D}",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.hpb.2016.10.012",
language = "English (US)",
volume = "19",
pages = "154--161",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous thromboembolism chemoprophylaxis

AU - Le, Anh Thu

AU - Harris, Jennifer W.

AU - Maynard, Erin

AU - Dineen, Sean P.

AU - Tzeng, Ching Wei D

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85007313273&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007313273&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2016.10.012

DO - 10.1016/j.hpb.2016.10.012

M3 - Article

VL - 19

SP - 154

EP - 161

JO - HPB

JF - HPB

SN - 1365-182X

IS - 2

ER -