Korean J Anesthesiol.  1988 Aug;21(4):575-583. 10.4097/kjae.1988.21.4.575.

Effects of Prolonged Major Surgery and Massive Transfusion on the Coagulation and Fibrinolysis System

• Lee HW
• Lim HJ
• Chang SH
• Shin JS

• KMID: 1933129
• DOI: http://doi.org/10.4097/kjae.1988.21.4.575

Abstract

The anesthesiologist is sometime presented with the problem of coagulation defects through the perioperative period. The possible causes of inappropriate hemostasis in this situation are numerous, and multiple mechanism may be simultaneously involved. Coagulation and fibrinolysis variables were measured in 15 patients who had undergone prolonged major surgery or received massive transfusion before and until 10 days after operation. Hemostactic surveys included platelet count, fibrinogen, prothrombin time, activated partial thromboplastin time, antithrombin lll, and fibrin degraduation products. No patients had major hemorrhage, thrombosis, or disseminated intravascular coagulation, but laboratory findings suggest that a hypercoagulable state existed even 10 days postoperatively. The results were as follows: 1) Platelet counts decreased just after operation, but significantly increased to 154% of the control value 7 days after operation and 204% 10 days postoperatively. 2) Prothrombin time was significantly prolonged just after operation compared to the control value, but returned to normal in 4 days postoperatively. 3) Fibrinogen decreased just after operation, but significantly increased to 165% of the control value 4 days after operation, 178% 7days after operation and 191% 10 days postoperatively. 4) Activated partial thromboplastin time was not changed through the entire period. 5) Antithrombin lll was not changed through the entire period. 6) Fibrin degradation product was within normal ranges before operation, but in 11 cases it exceeded normal range from 1 to 10 days postoperatively.

Keyword

Prolonged major surgery; Massive transfusion; Platelet count; Prothrombin time; Fibrinogen; Activated partial thromboplastin time; Antithrombin lll; Fibrin degradation product

MeSH Terms

Disseminated Intravascular Coagulation
Fibrin
Fibrinogen
Fibrinolysis*
Hemorrhage
Hemostasis
Humans
Partial Thromboplastin Time
Perioperative Period
Platelet Count
Prothrombin Time
Reference Values
Thrombosis
Fibrin
Fibrinogen