Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by thromboelastography: a pilot study

Abstract

Background and Objectives: Postoperative thromboembolism is a significant cause of prolonged recovery in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Thromboelastography (TEG) can detect hypercoagulable states and predict thromboembolic complications after surgery. This study assessed the impact of CRS and HIPEC on TEG values. Methods: TEG parameters reaction time (R), kinetics time (K), angle (a), maximum amplitude (MA), and lysis percent at 60 min (LY60) were determined preoperatively, and at the end of CRS, during HIPEC, and at the end of the operation using blood samples from 15 HIPEC patients. Platelets, P-TT, and aPTT were also determined before and after CRS. Results: A total of 75 samples were analyzed. During CRS, there was a significant reduction in the mean MA (3.06 mm, p ¼ 0.001). The mean P-TT declined by 32% (p < 0.001) and mean platelets by 55 Â 10 9 /L (p < 0.001). During HIPEC, the mean R and K shortened by 1.04 min (p ¼ 0.015) and 0.18 min (p ¼ 0.018), respectively, whereas a increased by 2.48 (p ¼ 0.005). Conclusions: During CRS, both TEG and conventional laboratory tests indicated hypocoagulation. During HIPEC, however, the initiation of coagulation and the kinetics of thrombin formation were accelerated. ARTICLE HISTORY

Changes in Coagulation in Cancer Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Treatment (HIPEC)—A Systematic Review

“…15,24,[35][36][37][38][39][40][41][42][43][44][45][46][47] Out of 15 studies, 13 studies reported primary tumor location (93%). 15,24,[35][36][37][38][39][40][41][42][43][44][45][46] Neoadjuvant chemotherapy was administered in two studies. 7,24…”

“…Ten studies reported the peritoneal carcinomatosis index ranging from 0 to 39. 15,24,[36][37][38][39]41,[43][44][45] Length of surgery was reported from 240 to 1,080 minutes in 13 studies. 15,24,[35][36][37][38][39]41,[43][44][45][46][47] The HIPEC method was reported in 13 out of 15 studies.…”

“…15,24,[35][36][37][38][39]41,[43][44][45][46][47] The HIPEC method was reported in 13 out of 15 studies. 15,24,35,36,[38][39][40][41][43][44][45][46][47] Six studies used the open abdomen method, 24,35,[38][39][40]44,45 four used the closed abdomen method, 41,43,46,47 and two used both methods for HIPEC. 15,36 Intraperitoneal chemotherapy solutions were reported in 13 of 15 studies, 15,24,35,36,[38][39][40][41][43][44][45]…”

“…15,36 Intraperitoneal chemotherapy solutions were reported in 13 of 15 studies, 15,24,35,36,[38][39][40][41][43][44][45][46][47] with oxaliplatin utilized in four studies 15,24,39,41 and mitomycin-c in eight studies. 15,24,36,40,[43][44][45]47 Cisplatin was also used in eight studies, 15,24,40,[43][44][45][46][47] either as monotherapy or in combination with mitomycin-c 15,40,43,44 or doxorubicin. 15,40,[43][44][45]47 Four studies reported the use of dextrose-based solutions with oxaliplatin 39,41 and mitomycin-c. 45 Four studies reported intraperitoneal solutions containing sodium chloride with either mitomycin-c or cisplatin.…”

“…15,40,[43][44][45]47 Four studies reported the use of dextrose-based solutions with oxaliplatin 39,41 and mitomycin-c. 45 Four studies reported intraperitoneal solutions containing sodium chloride with either mitomycin-c or cisplatin. 16,36,44,46 HIPEC temperature ranged from 40 to 42.5°C 15,35,36,39,41,[43][44][45][46][47] reported in 10 out of 15 studies with perfusion time from 30 to 90 minutes. 15,35,36,39,41,[43][44][45][46][47] Intraoperative blood loss ranged from 100 to 9,000 mL in eight studies reporting this information.…”