Fibrinolytic system changes in liver surgery : A pilot observational study

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dc.contributor.authorOzolina, Agnese
dc.contributor.authorNemme, Janis
dc.contributor.authorOzolins, Arturs
dc.contributor.authorBjertnæs, Lars J.
dc.contributor.authorVanags, Indulis
dc.contributor.authorGardovskis, Janis
dc.contributor.authorViksna, Ludmila
dc.contributor.authorKrumina, Angelika
dc.contributor.institutionRīga Stradiņš University
dc.date.accessioned2021-06-16T11:30:01Z
dc.date.available2021-06-16T11:30:01Z
dc.date.issued2018
dc.descriptionPublisher Copyright: © 2018 Ozolina, Nemme, Ozolins, Bjertnæs, Vanags, Gardovskis, Viksna and Krumina.
dc.description.abstractIntroduction: Bleeding occurs frequently in liver surgery. Unbalance between tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) concentrations might increase bleeding. Our aim was to analyze perioperative fibrinolytic changes during liver surgery. Materials and Methods: We evaluated 15 patients for inclusion into a prospective pilot study of liver surgery. We assessed fibrinolysis by plasma PAI-1 and t-PA: before surgery (T1), before Pringle maneuver (PM;T2), at the end of surgery (T3) and 24 h postoperatively (T4), and registered demographic and laboratory data, extent and duration of surgery, hemodynamic parameters, blood loss, and transfused volumes of blood products. Data presented as mean ± SD. Significance at P < 0.05. Results: After exclusion of six patients only undergoing biopsies, we included six women and three men aged 49.1 ± 19.6 years; two patients with liver metastases of colorectal cancer and hepatocellular carcinoma, respectively, two with focal nodular hyperplasia, two with hepatic hemangioma, and one with angiomyolipoma. Six patients underwent PM. PAI-1 plasma concentration (n = 9) rose from 6.25 ± 2.25 at T1 through 17.30 ± 14.59 ng/ml at T2 and 28.74 ± 20.4 (p = 0.007) and 22.5 ± 16.0 ng/ml (p = 0.04), respectively, at T3 and T4. Correspondingly, t-PA plasma concentration (n = 9) increased from 4.76 ± 3.08 ng/ml at T1 through 8.00 ± 5.10 ng/ml (p = 0.012) at T2 and decreased to 4.25 ± 2.29 ng/ml and 3.04 ± 3.09 at T3 and T4, respectively. Plasma t-PA level at T2 was significantly different from those at T1, T3, and T4 (p < 0.004). In PM patients, t-PA levels increased from T1, peaked at T2 (p = 0.001), and subsequently decreased at T3 and T4 (p = 0.011 and p = 0.037), respectively. Mean blood loss was 1,377.7 ± 1,062.8 ml; seven patients received blood products. Patients with higher PAI-1 levels at T3 received more fresh frozen plasma (r = 0.79; p = 0.01) and red blood cells (r = 0.88; p = 0.002). Conclusions: During liver surgery, fibrinolysis increased, as evidenced by rises in plasma PAI-1and t-PA, especially after start of surgery and following PM. Transfused volumes of blood products correlated with higher plasma concentrations of PAI-1. Confirming this tendency requires a larger cohort of patients.en
dc.description.statusPeer reviewed
dc.format.extent8
dc.format.extent863131
dc.identifier.citationOzolina, A, Nemme, J, Ozolins, A, Bjertnæs, L J, Vanags, I, Gardovskis, J, Viksna, L & Krumina, A 2018, 'Fibrinolytic system changes in liver surgery : A pilot observational study', Frontiers in Medicine, vol. 5, no. SEP, 253. https://doi.org/10.3389/fmed.2018.00253
dc.identifier.doi10.3389/fmed.2018.00253
dc.identifier.urihttps://dspace.rsu.lv/jspui/handle/123456789/5111
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85062698559&partnerID=8YFLogxK
dc.language.isoeng
dc.relation.ispartofFrontiers in Medicine
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectFibrinolysis
dc.subjectLiver surgery
dc.subjectPAI-1
dc.subjectPlasminogen activator inhibitor type 1
dc.subjectT-PA
dc.subjectTissue plasminogen activator
dc.subject3.2 Clinical medicine
dc.subject1.1. Scientific article indexed in Web of Science and/or Scopus database
dc.subjectGeneral Medicine
dc.subjectSDG 3 - Good Health and Well-being
dc.titleFibrinolytic system changes in liver surgery : A pilot observational studyen
dc.type/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article

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