OHSU

Liver resection

Coagulopathy with Liver Resection: Is TEG® testing more informative clinically than standard PT INR testing in identification of hypo- and hypercoagulability?

Principal Investigator: Kevin Billingsley, MD

What is the Liver Resection study?

The purpose of this study is to examine the changes in clotting that take place after part of the liver has been removed in surgery (resection). One of the functions of the liver is to make substances for blood clotting. After a resection, the production of these substances may change. There are several blood tests that can check clotting. Traditional tests like prothrombin time (PT INR) use only part (plasma) of a blood sample. A thrombelastogram® (TEG®) uses whole blood. We will compare the results of a traditional clotting test (PT INR) to the TEG® to see if TEG® more accurately reflects the effect liver resection has on clotting. This study will likely benefit future patients by making liver surgery as safe as possible.

Why do this study?

Alterations in coagulation after liver resection are difficult to predict. Though the prothrombin time is elevated in patients undergoing liver resection, the impaired synthesis of both clotting factors and anticoagulants results in a situation in which the functional coagulation profile of these patients is largely unknown. Prior studies have demonstrated that in states of injury, PT INR is actually an inferior measurement for determining a coagulation profile as compared to thrombelastography® (TEG®). TEG® is a point of care blood test for testing the efficiency of coagulation in blood. This test can provide information about clot strength and elasticity as well as platelet activation, fibrin formation, and clot retraction. Multiple studies have utilized TEG results to guide therapy in coagulation disorders, as well as monitor for hypercoagulability postoperatively.

Who will be included?

Patients scheduled for a major liver resection will be eligible to participate.

What is involved?

This is an observational study where a blood sample will be drawn before and after surgery and in the morning on the five days following surgery to assess changes in coagulation. We will analyze both the traditional clotting test (PT/INR) and TEG® results to see how clotting changes after surgery. We will also compare the results of these test to clinical outcomes such as deep leg clots, lung clots, excessive bleeding, and need for plasma transfusion.

For more information, contact Diane Lape at 503 494-4315 or by email at