Thrombelastographic evaluation of coagulation in transurethral prostatectomy

Abstract

Objective To assess the changes in overall coagulation status and define the degree of systemic fibrinolysis occurring in patients undergoing transurethral prostatectomy (TURP). Patients and methods Thirty patients undergoing TURP, 23 for benign prostatic hyperplasia and seven for prostatic carcinoma, were studied prospectively. Serial venous blood samples were taken using the two‐syringe technique. Samples were taken before, during and at intervals up to 72 h and 10–14 days after surgery. Thrombelastography (TEG) was performed on native whole blood samples. Peri‐operative blood loss was assessed, until the catheter was removed, by photometric estimation of the haemoglobin content of the irrigant fluid and the measurement of clot volume. Results There was no evidence of fibrinolysis (TEG Percentage Clot Lysis Ly60 >15%) in any patient over the whole peri‐operative period. There was a significant change in the mean TEG variables towards hypercoagulation from 3 h until 10–14 days post‐operatively, compared with the pre‐operative values (P<0.05). There was a significant correlation between blood loss and clot volume. Conclusion These results question the role of systemic fibrinolysis in primary and secondary haemorrhage following TURP and thus the rationale of using antifibrinolytics in these patients. The persistent hypercoagulable state post‐operatively indicates a possible role of hypercoagulability in clot retention.

Thrombelastography/thromboelastometry

“…, 1997). Hypercoagulable TEG ® results (reduced clot time, increased alpha angle and clot strength) (Figure 3) have been found in other surgical studies (Bell et al. , 1996; Goobie et al.…”

Application of ROTEM to assess hypercoagulability in patients with lung cancer

“…This has the additional benefit of measuring fibrinolytic activity and thus assesses global coagulation from clot formation to fibrinolysis by generation of a TEMogram [17]. Currently, both TEG and ROTEM are used in clinical practice to evaluate haemostasis, monitor bleeding and guide transfusion in patients with trauma, cardiac disease and those undergoing surgery [18][19][20][21][22]. Furthermore, ROTEM has been used to identify hypercoagulability in pregnancy [23,24], suggesting that it has use in quantifying both hypo-and hypercoagulable states.…”

The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate

“…Bell et al [19] reported that the thromboelastogrphy (TEG) parameters reflect a hypercoagulable state during and after TURP and that this change is caused by the inhibition of the fibrinolytic system. Conversely, Nielsen et al [20] concluded that the fibrinolytic system is activated during TURP due to surgical trauma.…”