Perioperative Coagulation Changes in Total Pancreatectomy and Islet Autotransplantation

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Abstract

Objectives Thrombotic complications after total pancreatectomy with islet autotransplantation (TPIAT) are common. However, the systemic changes to coagulation in the perioperative period have not been well studied. Our objective was to evaluate the derangements in coagulation in the perioperative period for this procedure. Methods This was a prospective observational study of patients undergoing elective TPIAT for chronic pancreatitis. Multiple methods of evaluating coagulation, including 2 viscoelastic assays and standard laboratory assays were obtained at defined intraoperative and postoperative intervals. Results Fifteen patients were enrolled. Laboratory values demonstrated initial intraoperative hypercoagulability before significant systemic anticoagulation after islet infusion with heparin. Hypercoagulability is again seen at postoperative days 3 and 7. Subgroup analysis did not identify any major coagulation parameters associated with portal vein thrombosis formation. Conclusions Apart from the immediate period after islet cell and heparin infusion, patients undergoing TPIAT are generally hypercoagulable leading to a high rate of thrombotic complications. Portal vein thrombosis development had minimal association with systemic derangements in coagulation as it is likely driven by localized inflammation at the time of islet cell infusion. This study may provide the groundwork for future studies to identify improvements in thrombotic complications.

Original languageEnglish (US)
Pages (from-to)671-677
Number of pages7
JournalPancreas
Volume51
Issue number6
DOIs
StatePublished - Jul 1 2022

Bibliographical note

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • CP - chronic pancreatitis
  • DVT - deep vein thrombosis
  • ICU - intensive care unit
  • IEQ - islet equivalent
  • INR - international normalized ratio
  • IQR - interquartile range
  • LOS - length of stay
  • PCA - principal component analysis
  • PE - pulmonary embolism
  • POD - postoperative day
  • PVT - portal vein thrombosis
  • TEG - thromboelastography
  • TPIAT
  • TPIAT - total pancreatectomy with islet autotransplantation
  • chronic pancreatitis
  • coagulation
  • thromboelastography

PubMed: MeSH publication types

  • Journal Article
  • Observational Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural

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