THE ALTERATIONS OF PLATELET COUNTS AND PT-INR LEVELS AFTER RIGHT HEPATECTOMY AND ANTICOAGULANT PROPHYLAXIS

Background: Anticoagulant prophylaxis for major hepatectomy operations is still unclear. Liver plays a main role on hemostasis and coagulation parameters are disturbed by major hepatectomies. The risk of thromboembolism increases after the hepatectomies as in other major abdominal operations. However, presence of anticoagulant prophylaxis constitute a significant risk of bleeding complications. Here, we aimed to interpret the effects of donor hepatectomies on the coagulation functions and to evaluate the role of safe anticoagulant prophylaxis. Material and Methods: The retrospective data included the healthy 100 adult patients who underwent right-lobe donor hepatectomy (RLDH) for living donor liver transplantation (LDLT). Anticoagulant prophylaxis was applied none of these patients. Perioperative hematological laboratory tests for 3 days and the incidence of postoperative clinical thromboembolic events were evaluated. Results: The mean age was 30.8 (ranged 18-61) and 45 of them were women. Hemoglobin, hematocrit and platelet values decreased till postoperative day 2 (p<0.05) and started to increase on day 3. PT, aPTT and INR values increased till postoperative day 2 and trend to be normal on day 3. There was no thrombo-embolic event. All of the donors remained alive with normal liver functions. Conclusions: Major liver resections, particularly RLDH, are different from other operations of general surgery with their effect on coagulation cascade. Coagulation abnormalities that may be seen in proportion with the liver resection must be taken into consideration in donors and routine anticoagulant treatment protocols might be reviewed when the postoperative bleeding is most hazardous. Patients who have the risk of postoperative thromboembolic complications should be reassessed after the postoperative second day.