MASSIVE ASCITIC FLUID LOSS AND COAGULATION DISTURBANCES AFTER LIVER-TRANSPLANTATION

被引:27
作者
GANE, E
LANGLEY, P
WILLIAMS, R
机构
[1] UNIV LONDON KINGS COLL HOSP,INST LIVER STUDIES,LONDON SE5 9RS,ENGLAND
[2] UNIV LONDON KINGS COLL,SCH MED & DENT,LONDON,ENGLAND
关键词
D O I
10.1016/0016-5085(95)90653-3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: A unique syndrome in which massive ascitic fluid loss developing 1-4 weeks after orthotopic liver transplantation (OLT) was associated with a hypercoagulable state and thrombotic complications is described. After OLT, severe coagulation abnormalities (international normalized ratio, 4.6) developed in a patient with ascitic losses of up to 12 L/day, The patient developed hypovolemia and severe systemic antithrombin III deficiency and venoocclusive disease in the graft. The aim of this study was to determine the prevalence of this syndrome after OLT, Methods: Coagulation studies were performed in 25 additional patients with large ascitic fluid losses after OLT and in 7 cirrhotic patients not undergoing transplantation. Results: All transplant recipients developed systemic deficiencies of multiple coagulation factors including antithrombin III. Markers of prothrombin activation were significantly elevated in both ascites and serum in all patients, and thrombotic complications subsequently developed in 5 patients. In the 7 cirrhotic patients, markers of prothrombin activation remained normal or minimally elevated and thrombotic complications were not found. Conclusions: Massive ascitic losses after OLT may lead to a hypercoagulable state from unreplaced losses of plasma coagulation factors into ascites and accumulation of thrombin in the systemic circulation. Hypovolemia and major coagulation abnormalities should be corrected with fresh frozen plasma, which may prevent the development of thrombotic complications.
引用
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页码:1631 / 1638
页数:8
相关论文
共 20 条
  • [1] ADDONIZIO VP, 1987, SURGERY, V101, P753
  • [2] EVIDENCE FOR THE PRODUCTION OF HIGH AMOUNTS OF INTERLEUKIN-6 IN THE PERITONEAL-CAVITY OF PATIENTS WITH ASCITES
    ANDUS, T
    GROSS, V
    HOLSTEGE, A
    WEBER, M
    OTT, M
    GEROK, W
    SCHOLMERICH, J
    [J]. JOURNAL OF HEPATOLOGY, 1992, 15 (03) : 378 - 381
  • [3] INCREASED TISSUE-TYPE PLASMINOGEN-ACTIVATOR ACTIVITY IN ORTHOTOPIC BUT NOT HETEROTOPIC LIVER-TRANSPLANTATION - THE ROLE OF THE ANHEPATIC PERIOD
    BAKKER, CM
    METSELAAR, HJ
    GROENLAND, TN
    GOMES, MJ
    KNOT, EAR
    HESSELINK, EJ
    SCHALM, SW
    STIBBE, J
    TERPSTRA, OT
    [J]. HEPATOLOGY, 1992, 16 (02) : 404 - 408
  • [4] DZIK WH, 1988, BLOOD, V71, P1090
  • [5] EFFECT OF LABORATORY VARIATION IN THE PROTHROMBIN-TIME RATIO ON THE RESULTS OF ORAL ANTICOAGULANT-THERAPY
    ECKMAN, MH
    LEVINE, HJ
    PAUKER, SG
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (10) : 696 - 702
  • [6] THE MOLECULAR-BASIS OF BLOOD-COAGULATION
    FURIE, B
    FURIE, BC
    [J]. CELL, 1988, 53 (04) : 505 - 518
  • [7] GIBSON PR, 1981, AUST NZ J MED, V11, P8
  • [8] HAAGSMA EB, 1985, LIVER, V5, P123
  • [9] DISSEMINATED INTRA-VASCULAR COAGULATION WITH THE PERITONEOVENOUS SHUNT
    HARMON, DC
    DEMIRJIAN, Z
    ELLMAN, L
    FISCHER, JE
    [J]. ANNALS OF INTERNAL MEDICINE, 1979, 90 (05) : 774 - 776
  • [10] KANG YG, 1985, ANESTH ANALG, V64, P888