Rotational Thrombo Elastometry and Standard Coagulation Tests for Hepatic Patients undergoing Major Liver Resection

Background: Coagulopathy can associate right hepatotomy in cirrhotic patients. Methods: 20 cirrhotic patients were prospectively studied for 10 days with rotational thromboelastometry (ROTEM) and standard coagulation tests (SCTs). EXTEM and INTEM of ROTEM represent extrinsic and intrinsic coagulation pathways respectively. FIBTEM (ROTEM) represents fibrinogen activity. SCTS include Prothrombin time (PT), activated partial thromboplastin time (aPPT), fibrinogen and platelets. Results: Age and body mass index were 55.9 ± 6.9 years and 23.7 ± 3.1 Kg/m2. Males: Female (11:9). ROTEM parameters were normal except for a prolonged clotting time (CT) on day 1 and 3, associated with a normal clotting formation time (CFT). CT and PT were maximum on day 1 (86.25+15.7 mm and 17.2 ± 2.2 sec, p 0.05 respectively). CT and CFT of (INTEM) were also not in correlation with aPTT (r=0.16, r=0.21, p>0.05 respectively). Fibrinogen correlated with maximum clot firmness (MCF) of FIBTEM (r=0.5, p 0.05). Model of end stage liver disease (MELD) score correlated with preoperative CFT and MCF (EXTEM) (r=0.47, r=-0.48, p<0.05) respectively.