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Despite the evidence of perioperative hypercoagulability in cancer patients, there are no consistent data evaluating the extent, duration, and specific contribution of platelets and procoagulatory proteins by in vitro testing. This study compared efficacy of haemoviscoelastography versus thromboelastography for monitoring of coagulation imbalance.
Two hundred and forty-one patients undergoing surgery for abdominal cancer were examined for the efficacy of a variety of coagulation tests. A complete coagulation screening, thromboelastography (TEG) and haemoviscoelastography (HVG) were performed before and at the end of surgery.
We calculated the elastic shear modulus of standard MA (Gt) and HVG MA (Gh), which reflect the total clot strength and procoagulatory protein component, respectively. The difference was an estimate of the platelet component (Gp). There was a 16% perioperative increase of standard MA, corresponding to a 51% increase of Gt (P < 0.05) and a 79% to 87% contribution of the calculated Gp to Gt. We conclude that serial standard thromboelastography and the HVG viscoelastic test may reveal the independent contribution of platelets and procoagulatory proteins to clot strength. Using multiple linear regression, all coagulation, TEG and HVG variabilities were used to model postoperative hypercoagulation. Results showed that some components of the TEG failed to identify hypercoagulation (r < 0.2, P > 0.75). All components of the HVG test reflect postoperative coagulopathies.
Hypercoagulability is not reflected completely by standard coagulation monitoring and TEG, and seems to be predominantly caused by increased platelet reactivity. HVG provides a fast and easy-to-perform bedside test to quantify in vitro coagulation, and may be useful in determining the coagulation status of cancer patients perioperatively.