Sarah Bos

104 CHAPTER 6 Figure 6 . Absolute ETP levels from thrombomodulin modified thrombin generation testing in plasma of controls, and patients after PPPD prior to (-) and after (+) in vitro addition of anticoagulants. Start is after induction of anesthesia, POD = postoperative day. Shown are medians with error bars indicating interquartile ranges, and the proportional difference in ETP upon addition of anticoagulants. Statistical differences indicated are differences in proportional change in ETP upon addition of anticoagulants between controls and patients. * p < 0.05 vs controls, ** P < 0.01 vs controls, *** P < 0.001 vs controls. LMWH = low molecular weight heparin, UFH = unfractionated heparin, Dabi = dabigatran, Riva = rivaroxaban. Discussion In this study we found that patients undergoing HPB surgery are hypercoagulable when assessed with thrombomodulin-modified thrombin generation testing. Although an elevated INR during or after the procedure may suggest a bleeding tendency, the actual hemostatic status appears prothrombotic, which is in line with