An Experimental Study of the Sequential Determination of Molecular and Conventional Parameters for the Evaluation of the Coagulation and Fibrinolytic Status during the Anhepatic Phase

Norio Yoshimura, Takashi Hamashima, Chol-Joo Lee, Yoshio Ohsaka, Kazunori Hirakawa, Keitaro Kan, Hitoshi Yasui, Hisashi Amaike, Teruhisa Sonoyama, Hisakazu Yamagishi, Takahiro Oka

The Second Department of Surgery, Kyoto Prefectural University of Medicine

Although the development of veno-venous bypass technique during orthotopic liver transplantation (OLT) has decreased the mortality and morbidity of the patients, bleeding or thrombosis due to hemostatic disorders, especially during the anhepatic phase of surgery, are serious problems in OLT patients. In the present study, therefore, we assessed the efficacy of the molecular markers used to evaluate coagulation and fibrinolysis status during the anhepatic phase of surgery using a swine model. Total hepatectomy was performed in the swine (female, BW=20 kg, n=6) and maintained for 150 minutes with veno-venous bypass. Thrombin-antithrombin III complex (TAT) and fibrin monomer test (FM test) were analyzed as molecular markers of the coagulation state, and FDP-D dimer (DD) and plasmin-α₂ plasmin inhibitor complex (PIC) were analyzed as molecular markers of the fibrinolytic state. PT, fibrinogen (Fng), AT-III, heparastin (HP), FDP, tissue plasminogen activator (t-PA) and platelet counts were also analyzed as conventional parameters. TAT levels displayed a remarkable elevation in the early anhepatic phase, but FM test showed a slow change from (-) to (+) between 60 and 120 min of the anhepatic phase. On the other hand, DD levels displayed a remarkable elevation in the late anhepatic phase. PIC did not show any significant change. These data suggested that coagulation disturbances due to a consumption of elements developed in the early anhepatic phase and that fibrinolytic disturbances developed in the late period. Since molecular markers are more sensitive than conventional parameters, sequential determination of TAT and DD is recommended to evaluate the hemostatic status in the anhepatic stage of OLT.

Key words
veno-venous bypass, blood coagulation, fibrinolysis, molecular marker

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Norio Yoshimura The Second Department of Surgery, Kyoto Prefectural University of Medicine
465 Hirokoji, Kawaramachi, Kamikyo-ku, Kyoto, 602 JAPAN

Accepted
March 3, 1993

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