Document Detail


Effect of preoperative biliary drainage on coagulation and fibrinolysis in severe obstructive cholestasis.
MedLine Citation:
PMID:  20142756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
GOALS: To evaluate the function of coagulation and fibrinolysis in cholestatic patients before and after preoperative biliary drainage (PBD).
BACKGROUND: Cholestasis owing to an obstructive biliary malignancy is associated with postoperative complications related to a proinflammatory state, an impaired hepatic synthesis function, and a potential derangement of hemostasis. Hence, PBD is advocated for cholestatic patients undergoing major surgery.
STUDY: Plasma coagulation and fibrinolytic parameters were assessed in 24 cholestatic patients and 10 controls. In 9 cholestatic patients, the parameters were reassessed at least 4 weeks after PBD.
RESULTS: Compared with controls, cholestatic patients showed lower concentrations (P<0.001) of plasma vitamin K-dependent factors II and VII, whereas prothrombin time, activated partial thromboplastin time, and factor V were unaltered. Thrombin generation was increased in cholestatic patients, as reflected by higher plasma concentrations of thrombin-antithrombin complexes and D-dimers. Fibrinolysis was significantly impaired as evidenced by low plasminogen activator activity (PAA) owing to an increase in plasminogen activator inhibitor -1). Elevated markers for thrombin generation thrombin-antithrombin decreased after PBD from 10.7±1.2 to 5.7±0.7 ng/mL (P<0.05). Additionally, impairment of fibrinolysis in cholestatic patients resolved after PBD (plasminogen activator inhibitor-1 levels decreased from 19±1 to 10±1 IU/mL and plasminogen activator activity increased from 82±3 to 110±4%, respectively). D-dimers remained unaltered after PBD, likely because of normalization of coagulation and fibrinolytic activity.
CONCLUSIONS: Obstructive cholestasis is associated with a procoagulant state, despite an impaired vitamin K-dependent coagulation factor synthesis. Virtually all alterations in coagulation and fibrinolysis were reversed by biliary drainage.
Authors:
Jaap J Kloek; Michal Heger; Niels A van der Gaag; Ulrich Beuers; Thomas M van Gulik; Dirk J Gouma; Marcel Levi
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  44     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-17     Completed Date:  2011-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7910017     Medline TA:  J Clin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  646-52     Citation Subset:  IM    
Affiliation:
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. jaap.kloek@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Coagulation*
Blood Coagulation Factors / biosynthesis
Cholestasis / surgery*
Drainage / methods*
Female
Fibrinolysis*
Humans
Male
Middle Aged
Pancreaticoduodenectomy / methods
Postoperative Complications / etiology,  prevention & control
Preoperative Care / methods
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Blood Coagulation Factors

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