HIPEC as a risk factor for postoperative coagulopathy after cytoreductive surgery for peritoneal metastases

Sommariva, Antonio; Tonello, Marco; Migliori, Emanuele; Pizzolato, Elisa; Cenzi, Carola; Mirabella, Marica; Pilati, Pierluigi

doi:10.1007/s13304-022-01340-3

Cited by 1 publication

(4 citation statements)

References 34 publications

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“…53 In contrast, the study reported shorter aPTT following cytoreductive surgery with HIPEC. 53 Notably, no difference in the incidence of postoperative bleeding was reported between the groups. 53 The present review found prolonged INR, aPTT, and PT 10 postoperative days following cytoreductive surgery with HIPEC.…”

Section: Discussionmentioning

confidence: 74%

“…53 Notably, no difference in the incidence of postoperative bleeding was reported between the groups. 53 The present review found prolonged INR, aPTT, and PT 10 postoperative days following cytoreductive surgery with HIPEC. Also, fibrinogen was reported decreased to postoperative day 3 in three studies.…”

Section: Discussionmentioning

confidence: 92%

“…A recent study by Sommariva et al investigating postoperative hemostasis in cytoreductive surgery with HIPEC compared with cytoreductive surgery alone demonstrated a significantly increased incidence for severe coagulopathy defined as INR > 1.5, or aPTT ratio < 0.66, or platelet counts below 75 × 10 9 /L in the HIPEC group. 53 Furthermore, the study identified HIPEC as an independent risk factor for prolonged INR. 53 In contrast, the study reported shorter aPTT following cytoreductive surgery with HIPEC.…”

Section: Discussionmentioning

confidence: 96%

“…53 Furthermore, the study identified HIPEC as an independent risk factor for prolonged INR. 53 In contrast, the study reported shorter aPTT following cytoreductive surgery with HIPEC. 53 Notably, no difference in the incidence of postoperative bleeding was reported between the groups.…”

Section: Discussionmentioning

confidence: 96%

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Venous thromboembolism and postoperative bleeding are complications of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this systematic review was to summarize current knowledge on the effect of cytoreductive surgery with HIPEC on coagulation and fibrinolysis within 10 days after surgery. Studies were identified in PubMed, Embase, and Web of Science on December 12, 2022. Data on biomarkers of coagulation and fibrinolysis measured preoperatively up to the 10th postoperative day were extracted. Among 15 included studies, 13 studies reported markers of primary hemostasis. Eleven studies found reduced platelet count following cytoreductive surgery with HIPEC and two studies reported reduced platelet function. Twelve studies reported impaired secondary hemostasis until postoperative day 10 indicated by prolonged international normalized ratio, prothrombin time, and activated partial thromboplastin time. Fibrinogen was decreased in three studies from preoperative to postoperative day 3 switching to increased levels until postoperative day 10. In accordance, three studies found reduced maximum amplitude and maximum clot firmness by thromboelastography/thromboelastometry (ROTEM/TEG) on the first postoperative day indicating impaired clot strength. Four studies demonstrated increased d-dimer, factor (F) VIII, and thrombin generation during the 10 postoperative days. Four studies investigated fibrinolysis by ROTEM/TEG and plasminogen activator inhibitor-1 (PAI-1) after cytoreductive surgery with HIPEC reporting contradictive results. In conclusion, a decrease in platelet count and subtle changes in secondary hemostasis were found following cytoreductive surgery with HIPEC. Data on the effect of cytoreductive surgery with HIPEC on fibrinolysis are sparse and this needs to be further investigated.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 92%