Thromboelastogram Complements Conventional Coagulation Tests for Optimal Management of Epidural Catheters in Living Liver Donors.

BACKGROUND

Reducing postoperative pain and associated morbidity is key for early recovery in healthy, living liver donors. Thoracic epidural analgesia (TEA) is the preferred, time-honoured, and effective pain relief modality, but the safe removal of epidural catheters is often debated, given the deranged conventional coagulation tests (CCTs) like prothrombin time/international normalised ratio (PT/INR) in the early postoperative period in right lobe living donors (RLLDs).

AIM: In a prospective observational study conducted in 70 consecutive RLLDs in whom TEA was used for perioperative pain management, we compared the utility and efficacy of CCTs vs. thromboelastogram (TEG) in managing epidural catheter removal.

METHODS

CCTs and TEG analysis were performed simultaneously at baseline (before incision) and postoperatively on days 1, 3, and 5. We compared TEG parameters and CCTs till postoperative day (POD) 5 to determine their corroboration and relevance with respect to perioperative coagulation.

RESULTS

On POD 3, 53% of RLLDs had a deranged PT/INR, suggesting a hypo-coagulable state, this reduced to 4.3% on POD 5. However, the TEG analysis revealed a brief hypercoagulable state in the immediate postoperative period till POD 5, showing that CCTs alone may be misleading. No TEA-related complications were observed in any of the donors in this study.

CONCLUSION

TEG can be used to complement CCTs in guiding optimal management and safe removal of TEA catheters. Furthermore, in the light of these hypercoagulable changes, anti-thrombotic measures including early ambulation, use of pneumatic compression pumps, and/or low-molecular-weight heparin prophylaxis may be considered.