Background and Goal of Study: Hypocoagulability observed after major hepatic resection in conventional coagulation tests withhold thromboprophylaxis administration, despite being this surgery one  with the highest risk of thrombotic events. It has been shown that thromboelastometry (TEM) indicates a balanced coagulation status in this clinical context (Mallet 2016). The aim of the study is to document serial changes over time of conventional coagulation tests and TEM in patients undergoing major hepatic resection. 
Materials and Methods: Patients undergoing major hepatic resection for metastatic colorectal cancer were prospectively included. Standard coagulation test and TEM (ROTEM®) were measured simultaneously at baseline and day 5 after surgery. EXTEM and FIBTEM test were performed. Patients received standard thromboprophylaxis with enoxaparin starting in the first 24h after surgery. Values were expressed as a mean and SD. Non parametric and Spearman’s rho test were used.
Results and Discussion: Eight patients (5 male, 3 female),  50 ± 10 years old, constituted the study population.    TEM parameters were normal at baseline and despite a trend to shorter clot formation, they did not change significantly 5 days after surgery (Table 1).  To the contrary, prothrombin time decreased along this period (83% ±10%) vs (65% ±12%) p= 0.02.  Either thrombotic nor bleeding events were observed postoperatively. 
Conclusion(s): These results confirm that TEM reflects better the coagulation state following major liver surgery. Standard thromboprophylaxis may not be effective in reducing the thrombotic risk in these patients.



06 / Thromboelastometry prophyle after major liver resection.