Abstract Number: PO122
Meeting: ISTH 2021 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: In the past, chirrotic patients were usually considered 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 impaired 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 activity was slightly under normal range (54%).
Results: Very large piece of the liver was resected and the bleeding during the operation was severe so they decided to administer recombinant FVII.
On second postoperative day PT was 22%, INR 2.68. The third postoperative 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.
To cite this abstract in AMA style:
Skoko M, Mihic Lasan I, Bilic K, Stefic A, Jularic A, Dodig J, Bosnjak T, Misir Situm S, Brozovic G, Vrdoljak DV, Mihaljevic M, Vucemilo T, Marinkovic Strumberger T. Liver Resection and Perioperative Coagulation Management in Patient with Cirrhosis and HCC – A Case Report [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/liver-resection-and-perioperative-coagulation-management-in-patient-with-cirrhosis-and-hcc-a-case-report/. Accessed October 2, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/liver-resection-and-perioperative-coagulation-management-in-patient-with-cirrhosis-and-hcc-a-case-report/