Ramspoth et al identified risk factors for a coagulopathy appearing after liver resection. The authors are from University Hospital Aachen in Germany.
Patient selection: hepatic resection
Resections were performed for benign tumor, hepatocellular carcinoma, cholangiocarcinoma or metastatic carcinoma.
21% of patients in the study had cirrhosis but this was not identified as a risk factor.
Coagulopathy - one or more of the following:
(1) INR >= 1.4
(2) platelet count < 80,000 per µL
(3) aPTT > 38 seconds
A coagulopathy may be transient or persistent (still present on postoperative day 7).
Risk factors for coagulopathy:
(1) preoperative INR (use >= 1.1 in the implementation based on Table 1)
(2) peak postoperative serum lactate concentration (use >= 2.8 mmol/L based on Table 3)
(3) resected liver weight as percent of body weight (use >= 0.84% based on Table 2); this correlated with extended resections (>= 3 segments)
Additional risk factors for persistent coagulopathy:
(1) preoperative liver transaminases (AST > 60 U/L; ALT > 60 U/L per Table 1)
(2) volume of red blood cells and FFP transfused
