Coagulation profile after esophagectomy in SIRS and sepsis evaluated by thromboelastography and relationship with organ dysfunction development
Abstract
OBJECTIVES: Assessment of organ dysfunction development and relationship to coagulation changes measured by standard coagulation tests and thromboelastography in patients after major surgery. BACKGROUND: Some authors reported that hypercoagulation present in systemic inflammatory response syndrome (SIRS) is caused by infection, while others reported hypocoagulation.
We hypothesize that hemocoagulation status depends on severity and time course of sepsis/SIRS and that coagulation profile influences organ dysfunction. METHODS: Hemocoagulation profile was evaluated in patients undergoing surgical esophagectomy on the morning of surgery and then at 24-hour intervals for the following six days.
Results: From 34 analyzed patients, 26 went through postoperative SIRS and eight patients developed sepsis complication. Hypercoagulation trend was found in both nonseptic and septic patients early after operation represented by short R and K.
We also found significant correlation (p < 0.05) between antithrombin level and organ dysfunction score in both groups, for nonseptic group (r = 0.78, r(2) = 0.60) and for septic group (r = 0.94, r(2) = 0.88). CONCLUSION: Hemocoagulation in both SIRS and sepsis is initially accompanied by a hypercoagulation trend and low level of antithrombin is connected to organ dysfunction development.
Therefore, normal antithrombin level might prevent organ dysfunction in postoperative period (Fig. 1, Ref. 14).