Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by thromboelastography: a pilot study

Figures & data

Table 1. Patient and operation characteristics.

Total	n = 15
Age, mean (SD) [min–max]	56 years (9.6) [32–68]
Gender
Male	4
Female	11
ASA classification
1	2
2	13
BMI, mean [min–max]	26 [17–35]
Preoperative albumin, mean (SD) [min–max]	36 g/l (6.2) [25–43]
Comorbidities
Hypertension	7
Hypothyreosis	1
Asthma	1
Renal insufficiency	1
Diagnosis
Appendix mucinous carcinoma	10
Mesothelioma	3
Colon carcinoma	2
PCI, mean (SD) [min–max]	16 (10.8)[0–37]
Duration of the surgery, mean (SD) [min–max]	700 minutes (182) [489–1019 minutes]
Perioperative hemorrhage, mean (SD) [min–max]	647 mL (594) [100–1900 mL]
Chrystalloids, mean [min–max]	7267 mL [3000–15,000 mL]
Albumin, mean [min–max]	600 mL [0–1800 mL]
Red blood cells
0 units	10
1 unit	2
2 units	2
3 units	1
Platelets
0 units	15
Octaplas
0 units	13
1 unit	0
2 units	2

SD: standard deviation; ASA: American Society of Anesthesiologists; BMI: body mass index; PCI: peritoneal carcinosis index.

Figure 1. (a) The individual changes of TEG parameters reaction time (R, min); (b) maximum amplitude (MA, mm). Dashed line represents the median values. (Ptime for the change over study period).

Table 2. Mean values with standard deviation (SD) and median of TEG parameters during the study period.

	Preoperative	After CRS	40 min HIPEC (T3)	80 min HIPEC (T4)	End
	(T1)	(T2)			(T5)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
	[median]	[median]	[median]	[median]	[median]
R	6.5 (1.4) [6.5]	5.9 (1.0) [5.8]	5.2 (1.2) [5.3]	4.8 (1.3) [4.8]	4.8 (1.5) [4.9]
K	1.5 (0.3) [1.4]	1.4 (0.2) [1.4]	1.3 (0.2) [1.3]	1.3 (0.2) [1.3]	1.3 (0.2) [1.3]
α	68.5 (4.6) [68.6]	69.2 (2.8) [69.4]	70.0 (2.5) [70.3]	71.6 (2.7) [71.1]	71.4 (3.2) [71.2]
MA	69.6 (5.7) [69.6]	66.5 (3.4) [66.2]	67.3 (3.6) [66.1]	67.0 (3.7) [66.9]	66.2 (3.7) [66.0]
LY60	4.5 (3.8) [3.3]	2.4 (4.9) [1.1]	0.9 (1.2) [0.8]	1.8 (1.9) [1.2]	1.1 (0.9) [0.9]
P-TT	90.6% (18.8) [86%]	58.5% (20.4) [59%]
aPTT	34.1 (4.9) [34.5]	35.4 (6.3) [34.5]
Trom	282.3 (73.8) [289.0]	227.1 (54.2) [240.0]

CRS: cytoreductive surgery; SD: standard deviation; R: reaction time; K: kinetics time; α: angle; MA: maximum amplitude; LY60: lysis at 60 min; TT: thromboplastin time; aPTT: activated partial thromboplastin time; Trom: number of platelets.

Table 3. Mean change of tests between time points with 95% confidence interval (95% CI).

	CRS		HIPEC		Recovery		Study period
	(T1 − T2)		(T2 − T4)		(T4 − T5)		(T1 − T5)
	Change		Change		Change		Change
	(95% CI)	p Value	(95% CI)	p Value	(95% CI)	p Value	(95% CI)	p Value	Ptime^a
R	0.65	0.13	1.04	0.015	−0.01	0.97	1.69	0.002	0.018
	(−0.22 − 0.53)		(0.23 − 1.85)		(−0.33 − 0.32)		(0.74 − 2.71)
K	0.02	0.80	0.18	0.012	−0.04	0.37	0.16	0.047	0.048
	(−0.15 − 0.19)		(0.05–0.31)		(−0.13-0.05)		(<0.01–0.31)
α	−0.65	0.58	−2.48	0.005	0.47	0.4	−2.67	0.005	0.037
	(−3.01 − 1.77)		(−4.1 to −0.86)		(−0.69 − 1.62)		(−5.34 − 0.00)
MA	3.06	0.001	−0.48	0.589	1.06	0.24	3.64	<0.001	0.002
	(1.30 − 4.82)		(−2.24 − 1.28)		(−0.74 − 2.87)		(1.84 − 5.45)
LY60	2.13	0.14	0.64	0.182	0.65	0.18	3.42	0.002	0.016
	(−0.73 − 4.99)		(−2.0 − 3.28)		(−0.33 − 1.63)		(1.49 − 5.36)
P − TT	32.1	<0.001
	(21.9 − 42.2)
aPTT	−1.4	0.35
	(−4.4 − 1.6)
Trom	55.1	0.001
	(25.6 − 84.7)

^aAccording to linear mixed model.

CRS: cytoreductive surgery; CI: confidence interval; R: reaction time; K: kinetics time; α: angle; MA: maximum amplitude; LY60: lysis at 60 min; TT: thromboplastin time; aPTT: activated partial thromboplastin time; Trom: number of platelets.