Evaluation of Viscoelastic Coagulation Changes using Thromboelastography to Predict Postoperative Hemorrhage in Major Hepatic Resection Surgery

International Journal of Medicine and Medical Sciences | Vol. 15, No. 2, February 2025 | pp. 9–16

DOI: 10.46882/2025/IJMMS/150009

Original Research Article

Evaluation of Viscoelastic Coagulation Changes using Thromboelastography to Predict Postoperative Hemorrhage in Major Hepatic Resection Surgery

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Major hepatic resections disrupt balance in the clotting system, causing complex changes that increase the risk of severe postoperative bleeding. This prospective cohort study evaluated the accuracy of Thromboelastography (TEG) compared to conventional coagulation assays (CCA) for predicting significant postoperative hemorrhage following partial hepatectomy. We evaluated 120 adult patients undergoing elective hepatic resection for primary or metastatic liver tumors. Baseline and postoperative day 1 TEG parameters (reaction time [R], maximum amplitude [MA], and lysis at 30 minutes [LY30]) and CCA profiles (INR, prothrombin time, and platelet count) were measured, and blood loss volumes were tracked. Within 7 days post-surgery, significant postoperative hemorrhage requiring blood transfusions occurred in 18.3% (22/120) of the patients. In the bleeding group, postoperative day 1 TEG profiles showed hypocoagulability, characterized by a significantly prolonged R-time (9.4 ± 1.5 minutes vs. 5.2 ± 0.8 minutes in non-bleeding patients, p < 0.001) and a reduced MA value (38.4 ± 4.2 mm vs. 58.6 ± 5.1 mm, p < 0.001). Preoperative CCA values did not show significant differences between groups (p > 0.05). Receiver Operating Characteristic (ROC) analysis showed that a postoperative day 1 TEG MA cutoff value < 42 mm predicted severe hemorrhage with a sensitivity of 90.9%, a specificity of 84.7%, and an Area Under the Curve (AUC) of 0.92 (95% CI = 0.85–0.97). Viscoelastic monitoring via TEG provides superior prediction of postoperative bleeding risk in liver surgery compared to standard testing, serving as a valuable tool to guide targeted hemostatic therapies.

Keywords: Thromboelastography, Hepatic Resection, Postoperative Hemorrhage, Hypocoagulability, Maximum Amplitude, Blood Transfusion

Manuscript Timeline: Received: November 11, 2024; Revised: December 20, 2024; Accepted: January 14, 2025; Published: February 18, 2025.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of Viscoelastic Coagulation Changes using Thromboelastography to Predict Postoperative Hemorrhage in Major Hepatic Resection Surgery. International Journal of Medicine and Medical Sciences, 2025, 15(2): 9–16. DOI: 10.46882/2025/IJMMS/150009

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