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dc.contributor.authorWeinberg, Laurenceen
dc.contributor.authorScurrah, Nen
dc.contributor.authorParker, F Cen
dc.contributor.authorDauer, Ren
dc.contributor.authorMarshall, Jen
dc.contributor.authorMcCall, Peter Ren
dc.contributor.authorStory, David Aen
dc.contributor.authorSmith, Cen
dc.contributor.authorMcNicol, Larryen
dc.identifier.citationAnaesthesia and Intensive Care; 39(5): 847-53en
dc.description.abstractWe investigated the possibility that despite postoperative derangements of routine laboratory coagulation tests, markers of coagulation activation and thrombin generation would be normal or increased in patients undergoing hepatic resection for cancer In addition to the conventional coagulation tests prothrombin time and activated partial thromboplastin time, we measured select markers of coagulation activation prothrombin fragments 1 and 2 (PF1 + 2), thrombin-antithrombin complexes and plasma von Willebrand Factor antigen in 21 patients undergoing hepatic resection. The impact of hepatic resection on coagulation and fibrinolysis was studied with thromboelastography. Preoperatively, routine laboratory coagulation and liver function tests were normal in all patients. On the first postoperative day, prothrombin time was prolonged (range 16 to 22 seconds) in eight patients (38%). For these patients, thromboelastography was normal in six (75%), PF1 + 2 was elevated in four (50%), and thrombin-antithrombin complexes and von Willebrand Factor antigen were elevated in all, which was evidence of acute phase reaction, sustained coagulation factor turnover and activation. By the fifth postoperative day, despite normalisation of prothrombin time, markers of increased coagulation activity remained greater than 85% of baseline values. The findings indicate that in patients undergoing liver resection for cancer, there is significant and prolonged postoperative activation of the haemostatic system despite routine coagulation tests being normal or even prolonged. Before considering therapeutic interventions an integrated approach to interpreting haematological data with clinical correlation is essential.en
dc.subject.otherAntithrombin IIIen
dc.subject.otherBiological Markers.blooden
dc.subject.otherBlood Coagulationen
dc.subject.otherEnzyme-Linked Immunosorbent Assayen
dc.subject.otherLiver Neoplasms.blood.surgeryen
dc.subject.otherMiddle Ageden
dc.subject.otherPartial Thromboplastin Timeen
dc.subject.otherPeptide Fragments.blooden
dc.subject.otherPeptide Hydrolasesen
dc.subject.otherProspective Studiesen
dc.subject.otherProtein Precursors.blooden
dc.subject.otherProthrombin Timeen
dc.subject.otherYoung Adulten
dc.subject.othervon Willebrand Factoren
dc.titleMarkers of coagulation activation after hepatic resection for cancer: evidence of sustained upregulation of coagulation.en
dc.typeJournal Articleen
dc.identifier.journaltitleAnaesthesia and Intensive Careen
dc.identifier.affiliationDepartment of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australiaen
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