Author: Vazquez GE et al.
Canadian Journal of Anesthesia. doi:10.1007/s12630-025-02849-3
This retrospective cohort study analyzed 647 liver resection patients at the University of Iowa (2011–2023) to evaluate the ability of preoperative data to predict postoperative coagulation disturbances—defined as INR > 1.5, partial thromboplastin time > 40 sec, or platelet count < 100,000 × 10⁶/L—within 72 hours in patients eligible for epidural analgesia. Of these, 79% received thoracic epidurals, and the overall incidence of coagulation disturbance was 25%, most commonly thrombocytopenia (20%). Incidence was 11% on postoperative day 1 and 22% on day 2.
Greater liver resection volume was associated with coagulation disturbance (P < 0.001), but other preoperative factors—including sex, ASA classification, BMI, weight, age, chemotherapy status, operative duration, and year—showed no predictive value. Classification tree and logistic regression modeling failed to identify a clinically useful preoperative prediction; even the lowest predicted risk exceeded 5% by 72 hours post-op.
The authors conclude that preoperative qualification criteria for epidural use are insufficient to determine which liver resection patients will develop postoperative coagulopathy. Enhanced recovery protocols recommending early epidural catheter removal must account for the timing of these coagulation changes.
References
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Vazquez GE, Dexter F, Vasanwala RS, et al. Can J Anesth. 2025. doi:10.1007/s12630-025-02849-3.
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