Abstract
Hepatobiliary surgery is a well-known risk factor for thrombotic complications but
is also associated with substantial perioperative blood loss. Given the central role
of the liver in hemostasis, hepatobiliary surgery is frequently accompanied by complex
changes in the hemostatic system. Increasing knowledge of these changes has resulted
in an improved understanding of the etiology of some of the hemostatic complications.
In the early postoperative period a prolongation of conventional coagulation test
times, such as the prothrombin time, is frequently seen. Together with a decreased
platelet count, this suggests a hypocoagulable state. The concomitant decline of anticoagulant
factors and development of a von Willebrand factor/ADAMTS13 (a disintegrin and metalloproteinase
with a thrombospondin type 1 motif, member 13) imbalance, however, suggest a hypercoagulable
state, potentially contributing to the risk of thromboembolism. Postoperative thromboprophylaxis
should be initiated early to avoid thrombosis, and intensified prophylaxis might benefit
high-risk patients. The risk of hemorrhagic complications during hepatobiliary surgery
has diminished over time, mainly due to improved surgical and anesthesiological techniques.
However, bleeding can still be profound in individual patients and is difficult to
predict using (global) hemostasis tests. A restrictive transfusion and fluid infusion
policy to maintain a low central venous pressure is crucial in prevention of perioperative
bleeding. However, when active bleeding occurs, proactive prohemostatic management
is required.
Keywords
hepatectomy - liver transplantation - pancreatectomy - thrombosis - bleeding
