Prevalence and predictors of hypercoagulability detected by rotational thromboelastometry in peritoneal malignancy patients undergoing cytoreductive surgery

Elizabeth Skalkos; Mina Sarofim; Stephany Game; Ruwanthi Wijayawardana; Nima Ahmadi; David L. Morris

doi:10.18203/2349-2902.isj20240333

Authors

Elizabeth Skalkos Liver and Peritonectomy Unit, St George Hospital NSW, Australia; School of Medicine, University of New South Wales NSW, Australia
Mina Sarofim Liver and Peritonectomy Unit, St George Hospital NSW, Australia; School of Medicine, University of New South Wales NSW, Australia; School of Medicine, University of Sydney NSW, Australia
Stephany Game Department of Anaesthetics, St George Hospital NSW, Australia
Ruwanthi Wijayawardana Liver and Peritonectomy Unit, St George Hospital NSW, Australia; School of Medicine, University of New South Wales NSW, Australia
Nima Ahmadi Liver and Peritonectomy Unit, St George Hospital NSW, Australia; School of Medicine, University of New South Wales NSW, Australia
David L. Morris Liver and Peritonectomy Unit, St George Hospital NSW, Australia; School of Medicine, University of New South Wales NSW, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20240333

Keywords:

TEM, Thromboelastography, Peritoneal neoplasms, Peritoneal carcinomatosis, Cytoreduction surgical procedures, HIPEC

Abstract

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for peritoneal malignancy. A hypercoagulable state in these patients and the associated risk of venous thromboembolism (VTE), remains the most common cause of 30-day mortality. This study aimed to evaluate the prevalence and perioperative factors associated with baseline hypercoagulability detected by rotational thromboelastometry (ROTEM), a point-of-care haemostatic assay, in peritoneal malignancy patients.

Methods: A retrospective cohort study was performed in a peritoneal malignancy unit on patients undergoing CRS between 2019 and 2023, who underwent preoperative ROTEM testing. Patients were divided into group A (hypercoagulable) and Group B (normal coagulation). Baseline characteristics, pathology results, operative details and post operative outcomes were reviewed. Univariate and multivariate analysis were used to identify factors associated with baseline hypercoagulability.

Results: The 70 patients were included, 23 patients in group A (32.9%) and 47 patients in group B (67.1%). Group A had a lower preoperative haemoglobin (p<0.001), higher platelet count (p<0.001) and median peritoneal carcinomatosis index (33 vs 10, p=0.003). Appendiceal primary was associated with hypercoagulability (47.8% vs 23.4%, p=0.039). Group A required more intraoperative transfusion with red blood cells (p=0.014) but not platelets (p=0.6) or cryoprecipitate (p=0.8). Although group A had a higher incidence of VTE events (30.4% vs 23.4%) this was not statistically significant.

Conclusions: Baseline hypercoagulability exists in one-third of patients with peritoneal malignancy and was associated with increased tumour burden and appendiceal primary. The increasing use of ROTEM is a valuable tool for perioperative management of complex peritoneal malignancy patients.

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