Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial)
Background and Aims: The International Normalised Ratio (INR), which assesses the loss of procoagulant factors in the extrinsic pathway, fails to evaluate the coagulation abnormalities comprehensively after a major liver resection, which often leads to reduced synthesis of procoagulant and anticoagu...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2023;volume=67;issue=12;spage=1077;epage=1083;aulast=Ambulkar |
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| author | Reshma Ambulkar Vignesh Baskar Shraddha Patkar Aditya Kunte Vandana Agarwal Sohan Lal Solanki Jigeeshu V Divatia |
| author_facet | Reshma Ambulkar Vignesh Baskar Shraddha Patkar Aditya Kunte Vandana Agarwal Sohan Lal Solanki Jigeeshu V Divatia |
| author_sort | Reshma Ambulkar |
| collection | DOAJ |
| description | Background and Aims: The International Normalised Ratio (INR), which assesses the loss of procoagulant factors in the extrinsic pathway, fails to evaluate the coagulation abnormalities comprehensively after a major liver resection, which often leads to reduced synthesis of procoagulant and anticoagulant-factors. This study was conducted with an aim to study the trend and compare the results of routine coagulation tests and thromboelastography (TEG) during the perioperative period in patients undergoing major liver resections (≥3 segments). Methods: Twenty-five patients who underwent a major liver resection were enrolled. This prospective, single-arm, interventional study was performed with the primary objective of determining the serial changes in conventional coagulation tests and TEG during the perioperative period in patients undergoing major liver resections, at the preincision period, intraoperative period, postoperatively, at 48 h and on the fifth postoperative day. Transfusion requirements of blood components were also assessed with a TEG-guided replacement strategy. Spearman rank-order correlation was used to study the relationships of coagulation tests (both TEG and conventional tests) at each time point. Results: The prothrombin time (PT)-INR was elevated in 14 patients (56%) at the intraoperative, immediate postoperative and 48-h time points in contrast to the TEG parameters, which remained normal in all patients. Blood component transfusion was avoided in 4, 11 and 10 patients at the intraoperative, immediate postoperative and 48-h time points, respectively. Conclusion: International Normalised Ratio overestimates the coagulopathy in patients undergoing major liver resection, and a thromboelastography-guided transfusion strategy reduces overall transfusion requirements. |
| first_indexed | 2024-03-08T13:11:05Z |
| format | Article |
| id | doaj.art-313043f144104facaa23998887557d35 |
| institution | Directory Open Access Journal |
| issn | 0019-5049 0976-2817 |
| language | English |
| last_indexed | 2024-03-08T13:11:05Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj.art-313043f144104facaa23998887557d352024-01-18T12:28:30ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172023-01-0167121077108310.4103/ija.ija_344_23Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial)Reshma AmbulkarVignesh BaskarShraddha PatkarAditya KunteVandana AgarwalSohan Lal SolankiJigeeshu V DivatiaBackground and Aims: The International Normalised Ratio (INR), which assesses the loss of procoagulant factors in the extrinsic pathway, fails to evaluate the coagulation abnormalities comprehensively after a major liver resection, which often leads to reduced synthesis of procoagulant and anticoagulant-factors. This study was conducted with an aim to study the trend and compare the results of routine coagulation tests and thromboelastography (TEG) during the perioperative period in patients undergoing major liver resections (≥3 segments). Methods: Twenty-five patients who underwent a major liver resection were enrolled. This prospective, single-arm, interventional study was performed with the primary objective of determining the serial changes in conventional coagulation tests and TEG during the perioperative period in patients undergoing major liver resections, at the preincision period, intraoperative period, postoperatively, at 48 h and on the fifth postoperative day. Transfusion requirements of blood components were also assessed with a TEG-guided replacement strategy. Spearman rank-order correlation was used to study the relationships of coagulation tests (both TEG and conventional tests) at each time point. Results: The prothrombin time (PT)-INR was elevated in 14 patients (56%) at the intraoperative, immediate postoperative and 48-h time points in contrast to the TEG parameters, which remained normal in all patients. Blood component transfusion was avoided in 4, 11 and 10 patients at the intraoperative, immediate postoperative and 48-h time points, respectively. Conclusion: International Normalised Ratio overestimates the coagulopathy in patients undergoing major liver resection, and a thromboelastography-guided transfusion strategy reduces overall transfusion requirements.http://www.ijaweb.org/article.asp?issn=0019-5049;year=2023;volume=67;issue=12;spage=1077;epage=1083;aulast=Ambulkarblood transfusioncoagulationhepatectomyinternational normalised ratioperioperative outcomesprothrombin timethromboelastography |
| spellingShingle | Reshma Ambulkar Vignesh Baskar Shraddha Patkar Aditya Kunte Vandana Agarwal Sohan Lal Solanki Jigeeshu V Divatia Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial) Indian Journal of Anaesthesia blood transfusion coagulation hepatectomy international normalised ratio perioperative outcomes prothrombin time thromboelastography |
| title | Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial) |
| title_full | Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial) |
| title_fullStr | Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial) |
| title_full_unstemmed | Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial) |
| title_short | Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection – A single-arm, prospective, interventional trial (PORTAL trial) |
| title_sort | evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection a single arm prospective interventional trial portal trial |
| topic | blood transfusion coagulation hepatectomy international normalised ratio perioperative outcomes prothrombin time thromboelastography |
| url | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2023;volume=67;issue=12;spage=1077;epage=1083;aulast=Ambulkar |
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