Perioperative Coagulopathy in Patients Undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

Author(s): Joona Prabhakaran, Roopesh Sureshan, Jashma, Ratheesan Kumbakara

Background: Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has emerged as the treatment of choice for patients with peritoneal carcinomatosis. The surgery is associated with massive blood and fluid loss resulting in transfusion of intravenous fluids and blood products which can lead to alterations in normal coagulation cascade and can lead to coagulation abnormalities. Aim of study: Our study aims to find out the incidence of postoperative coagulopathy and factors contributing to it. We also aim to find out the incidence of postoperative thromboembolic complications. Materials and methods: Data of 43 patients who underwent CRS and HIPEC was collected from hospital medical records and was analyzed retrospectively. The primary outcome of our study was the incidence of postoperative coagulopathy. Abnormal coagulation was defined as platelet count less than 1 lakh/mm3, INR >1.5 and APTT> 45 sec. We recorded the coagulation profile the day before surgery, on the day of surgery and for the first five postoperative days. Details were collected about postoperative transfusion, occurrence of thromboembolic complications and mortality in the first 30 days after surgery. Result: 60% of the patients (26/43) developed coagulopathy perioperatively. ASA status of the patient, primary disease, postoperative transfusion and delta temperature had significant association with occurrence of postoperative coagulopathy. Greatest reduction in platelet count from preoperative value was on POD-3 with median value of 1.51 (IQR 0.52). Highest increase in INR was on POD-2 (median value of 1.45 (IQR 0.320)) and APTT was on POD-2 (median value of 40(IQR 10) seconds. Conclusion: The incidence of perioperative coagulopathy after CRS and HIPEC was very high in our study. ASA score, primary disease and delta temperature had significant association with development of postoperative coagulopathy. 9.3% of patients developed symptomatic thromboembolic complications in the first 30 days after CRS and HIPEC.

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