Naslov
Liver Resection and Perioperative Coagulation Management in Patient with Cirrhosis and HCC – A Case Report

Autori
Skoko, Marija ; Mihić Lasan, Irena ; Bilić, Karmen ; Štefić, Anita ; Jularić, Anamarija ; Dodig, Javorka ; Bošnjak, Tomislav ; Misir Šitum, Stanka ; Brozović, Gordana ; Vrdoljak, Danko Velimir ; Mihaljević, Mihaela ; Vučemilo, Tiha ; Marinković Strumberger, Tara

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Abstracts of the ISTH 2021 Virtual Congress of the International Society of Thrombosis and Haemostasis, u: Research and Practice in Thrombosis and Haemostasis / - Philadelphia (PA) : John Wiley & Sons, 2021, 85-86

Skup
29th Congress of the International Society on Thrombosis and Haemostasis (ISTH)

Mjesto i datum
Online, 17.07.2021. - 21.07.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
liver resection ; coagulation ; cirrhosis ; HCC

Sažetak
Background : In the past, chirrotic patients were usually consid-ered as patients with high risk of bleeding and hipocoagulability. The common practice was to correct coagulation parameters with plasma products and platelet. Cirrhosis is characterized by an im-paired synthesis of all clotting factors and thrombocytopenia. FVIII and vWf activity is usually increased. Aims : A case report of coagulation managament in a patient with hepatocellular carcinoma after hepatitis B active disease. Methods : 69 year old patient was admitted to our hospital for the liver operation. Preoperative routine blood tests were done. PT (prothrombin time) was prolonged (58%, INR 1.28) and fVII activ-ity was slightly under normal range (54%). Results : Very large piece of the liver was resected and the bleed-ing during the operation was severe so they decided to administer recombinant FVII. On second postoperative day PT was 22%, INR 2.68. The third post-operative day patient developed oedema of the right leg. D- dimers were very high >34.4 mg/L (normal range <0.5 mg/L). Ultrasound showed deep vein thrombosis of femoral and popliteal vein. On 10th day patient was infected with the SARS Cov- 2 virus. We continued therapeutic doses of LMWH. The coagulation status was normal (PV 76%) and D- dimer were 6.54 mg /L. She did not develop any major COVID – 19 symptoms. Conclusions : Our case report shows the poor prognosis of routine coagulation tests in patients with cirrhosis. The theory that includes two cascade ways is not enough in this case. In 2001 a new cell based model was proposed by Hoffman and Monroe. This model includes three phases. All phases of coagulation leads to thrombin generation. In the end thrombin initiates the conversion of fibrin resulting in a fibrin burst. Thrombin generation in these patients is normal or even enlarged and the risk for venous thromboembolisam is enlarged.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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