O-L04 Peri-operative thrombophilia in patients undergoing liver resection for colorectal metastases

Abstract Background The risk of major haemorrhage during liver surgery has decreased considerably in the modern era. However, there remains reluctance amongst surgeons to give routine peri-operative chemical thromboprophylaxis, either because perceived bleeding, or transient post-operative abnormalities conventional coagulation studies. aim this study was ask whether a defined, homogeneous population patients undergoing resection for colorectal metastases (CRM) were at from venous thromboembolism (VTE) prior surgery, and what impact on that risk. Methods A single-centre prospective observational cohort comparing pre-, peri- haemostasis variables CRM. Patients with cirrhosis, history VTE anticoagulated excluded, as small wedge, laparoscopic resections. Blood samples assays collected pre-operatively, peri-operatively (after transection) first day (13–20 hours post-operatively). Pre- Tissue Factor messenger ribonucleic acid (TFmRNA) activation measured peripheral blood mononuclear cells (PBMCs) using semi-quantitative polymerase chain reaction (PCR). received mechanical thromboprophylaxis until mobile, plus day, after venesection. Results Of 336 hepatectomies performed October 2017-December 2019, 60 resections 57 recruited. This included 46.7% resections, median (interquartile range [IQR]) loss 150.0mls (76.3-263.7), no transfusions, events deaths. prothrombotic pre-operatively (high factor VIIIC thrombin generation velocity index), an effect exacerbated post-hepatectomy. Major had significantly greater drop Protein C, rise von Willebrand Factor, versus minor (p = 0.001,0.005,0.001 respectively). transection times than (40minutes), increased (IQR) PMBC-TFmRNA expression [1.65 (0.93-2.70)2ddCt], quicker transections [0.99 (0.69-1.28)2ddCt, p 0.020]. Conclusions These data show elective high volume unit is low administration within 13-20 safe effective. demonstrates CRM are pre-operatively. Furthermore, thrombophilia by resection, most marked longer, more complex operations. suggest should be considered earlier patient pathway, resulted change practice authors.