A sustained decrease in plasma fibrinolytic potential following partial liver resection or pancreas resection

- Plasma levels of fibrinolytic proteins decrease during partial liver and pancreas resection.
- Levels recover more rapidly following a pancreas resection.
- The kinetics of recovery differs between the fibrinolytic proteins.
- A hypofibrinolytic status is present during the first week following both surgical procedures.
- Sustained hypofibrinolysis may contribute to thrombotic risk in both patient groups.

BackgroundPatients undergoing partial hepatectomy have a substantial risk for postoperative venous thrombosis even in the presence of optimal thromboprophylaxis. Recently we demonstrated a hypercoagulable state following a partial hepatectomy which was related to decreased plasma levels of natural anticoagulants and elevated levels of FVIII. The fibrinolytic status following partial hepatectomy has not been studied, but may display unique features as a result of temporarily decreased synthesis of fibrinolytic proteins.MethodsWe included 17 patients undergoing a partial hepatectomy and determined plasma fibrinolytic potential and measured plasma levels of individual fibrinolytic proteins in serial samples taken perioperatively. Results were compared to ten patients undergoing pancreas resection and twenty-four healthy volunteers.Results and conclusionFollowing both partial hepatectomy and pancreas resection plasma fibrinolytic potential decreased at the end of surgery, normalized on post-operative day 1, and decreased again on post-operative day 3 after which the hypofibrinolytic state gradually resolved. The hypofibrinolytic state on day 1 associated with increased plasma levels of PAI-1 in both groups. Plasma levels of plasminogen, α2-antiplasmin and TAFI all decreased following partial hepatectomy and pancreas resection and levels recovered over time. The kinetics of recovery were different for the different proteins and were slower in the liver resection group, resulting in a unique ratio of pro-to-anti-fibrinolytic proteins at each time point. This may explain the hypofibrinolytic status from day 3 onwards. A sustained plasma hypofibrinolytic state in combination with the hypercoagulable state we previously identified may contribute to the increased risk of thrombotic complications after partial liver resection.