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 generationthrombin-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.
RCT Entities:
GOALS: To evaluate the function of coagulation and fibrinolysis in cholestaticpatients 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 cholestaticpatients undergoing major surgery. STUDY: Plasma coagulation and fibrinolytic parameters were assessed in 24 cholestaticpatients and 10 controls. In 9 cholestaticpatients, the parameters were reassessed at least 4 weeks after PBD. RESULTS: Compared with controls, cholestaticpatients 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 cholestaticpatients, 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 cholestaticpatients 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: James P Luyendyk; Karen M Kassel; Katryn Allen; Grace L Guo; Guodong Li; Glenn H Cantor; Bryan L Copple Journal: Am J Pathol Date: 2011-03 Impact factor: 4.307
Authors: Kevin S Baker; Anna K Kopec; Asmita Pant; Lauren G Poole; Holly Cline-Fedewa; Dora Ivkovich; Mojtaba Olyaee; Benjamin L Woolbright; Adam Miszta; Hartmut Jaeschke; Alisa S Wolberg; James P Luyendyk Journal: Arterioscler Thromb Vasc Biol Date: 2019-08-15 Impact factor: 8.311
Authors: Greger Olsson; Farshad Frozanpor; Lars Lundell; Lars Enochsson; Christoph Ansorge; Marco Del Chiaro; Marcus Reuterwall-Hansson; Alysha Shetye; Urban Arnelo Journal: Endosc Int Open Date: 2017-09-05