Blasi Annabel, Molina Victor, Sanchez-Cabús Santiago, Balust Jaume, Garcia-Valdecasas J Carlos, Taura Pilar
Anesthesia Department, Hospital Clinic, Barcelona.
Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS).
Blood Coagul Fibrinolysis. 2018 Jan;29(1):61-66. doi: 10.1097/MBC.0000000000000672.
: Postoperative venous thromboembolism has a poor prognosis in patients with cancer. We aimed to investigate the utility of thromboelastometry in detecting the risk of postoperative venous thromboembolism in patients with cholangiocarcinoma. We prospectively included patients submitted to liver resection for cholangiocarcinoma at our hospital between May 2011 and July 2014. Patients undergoing major hepatectomy for adult living donor transplantation in the same time period served as a control group. Thromboelastometry was performed before anesthesia. Postoperative venous thrombotic events were recorded in the 6 months after surgery. Twenty-seven patients with cholangiocarcinoma and 17 living-donor liver transplantation patients were included. Maximum clot firmness and its derivative parameter G, pointed to hypercoagulability in patients with cholangiocarcinoma, whereas all parameters were within normal ranges in controls. Six postoperative thrombotic events were recorded: four portal vein thrombosis and two deep venous thrombosis, all in patients with cholangiocarcinoma. Patients with cholangiocarcinoma who displayed thrombotic complications showed a nonsignificant trend to more pronounced hypercoagulability compared with those without. The results suggest that first, in patients with cholangiocarcinoma, despite standard thromboprophylaxis, thrombotic events remain a substantial problem, and, second, thromboelastometry may be useful in identifying patients with cholangiocarcinoma at risk of postoperative venous thromboembolism. Large prospective studies are warranted to confirm these results.
癌症患者术后静脉血栓栓塞的预后较差。我们旨在研究血栓弹力图在检测胆管癌患者术后静脉血栓栓塞风险中的作用。我们前瞻性纳入了2011年5月至2014年7月期间在我院接受胆管癌肝切除术的患者。同期接受成人活体供肝移植大肝切除术的患者作为对照组。在麻醉前进行血栓弹力图检查。记录术后6个月内的静脉血栓形成事件。纳入了27例胆管癌患者和17例活体供肝移植患者。最大血凝块硬度及其衍生参数G显示胆管癌患者存在高凝状态，而对照组所有参数均在正常范围内。记录到6例术后血栓形成事件：4例门静脉血栓形成和2例深静脉血栓形成，均发生在胆管癌患者中。与无血栓形成并发症的胆管癌患者相比，出现血栓形成并发症的胆管癌患者高凝状态更明显，但差异无统计学意义。结果表明，首先，在胆管癌患者中，尽管采取了标准的血栓预防措施，血栓形成事件仍然是一个严重问题；其次，血栓弹力图可能有助于识别有术后静脉血栓栓塞风险的胆管癌患者。需要进行大型前瞻性研究来证实这些结果。
