Sarah Bos

70 CHAPTER 5 Preoperative Intraoperative Postoperative PH LT PH LT PH LT Platelet count Normal Decreased Decreased Following an initial decrease, normalization at day 10-14 with no thrombocytosis VWF/ADAMTS13 - High VWF - Slightly decreased ADAMTS13 - High VWF - Low ADAMTS13 - VWF no change - ADAMTS13 further decrease - VWF slight decrease - ADAMTS13 substantial decrease, < 5% in some patients Day 30: - VWF remains elevated - ADAMTS13 decreased Day 10: - VWF remains elevated - ADAMTS13 decreased FVIII Slightly elevated Substantially elevated Slight increase Slight decrease Slightly elevated at day 30 Substantially elevated at day 10 Pro- and anticoagulant factors (except FVIII) Normal Substantially decreased Decreased Normalization at day 30 Normalization at day 10 Pro- and antifibrinolytic factors (except tPA and PAI-1) Normal Substantially decreased Decreased Normalization at day 30 Normalization at day 10 tPA/PAI-1 Normal Increased - tPA unknown - PAI-1 high at the end of surgery - tPA peak during anhepatic and/or reperfusion phases - PAI-1 high at the end of surgery Normalization at day 30 Normalization at day 10 Prothrombin time Normal Prolonged Prolonged Normalization after 5-7 days Thrombin generation Normal Hypercoagulable Hypercoagulable Normo- to hypercoagulable Sustained hypercoagulability until day 30 Sustained hypercoagulability until day 10 Plasma fibrinolytic potential Normal Slight hyperfibrinolysis Hypofibrinolysis at the end of surgery Hyperfibrinolysis during anhepatic and reperfusion phases, hypofibrinolysis at the end of surgery Second peak of hypofibrinolysis at day 3, normalization at day 30 Normalization at day 3-5 Thromboelastography Normal Hypo-, normo-, or hypercoagulable, dependent on etiology Normal Hypo-, normo- or hypercoagulable Increased fib-tem at day 5 Unknown Table 1 Changes in the hemostatic system prior to, during, and after partial hepatectomy in non-cirrhotic and liver transplantation in patients with cirrhotic livers Abbreviations: PH, partial hepatectomy; LT, liver transplantation; VWF, von Willebrand factor; tPA, tissue plasminogen activator; PA-1, plasminogen activator inhibitor-1. Data in this table are based on published studies of our laboratory [16,19,20,33,35,36,53] and others [37,42].