Publication

Coagulopathy following major liver resection: The effect of rBPI(21) and the role of decreased synthesis of regulating proteins by the liver

Meijer, C., Wiezer, MJ., Hack, CE., Boelens, PG., Wedel, NI., Meijer, S., Nijveldt, RJ., Muller, MGS., Wiggers, T., Zoetmulder, FAN., Rinkes, IHMB., Cuesta, MA., Gouma, DJ., van de Velde, CHJ., Tilanus, HW., Scotte, M., Thijs, LG. & van Leeuwen, PAM., Apr-2001, In : Shock. 15, 4, p. 261-271 11 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • C Meijer
  • MJ Wiezer
  • CE Hack
  • PG Boelens
  • NI Wedel
  • S Meijer
  • RJ Nijveldt
  • MGS Muller
  • T Wiggers
  • FAN Zoetmulder
  • IHMB Rinkes
  • MA Cuesta
  • DJ Gouma
  • CHJ van de Velde
  • HW Tilanus
  • M Scotte
  • LG Thijs
  • PAM van Leeuwen

This prospective study investigated the role of reduced hepatic synthesis of regulating proteins in coagulopathy after partial hepatectomy (PH) compared with major abdominal surgery (MAS) without involvement of the liver. Furthermore, we studied the effect of rBPI(21), an endotoxin-neutralizing agent, on coagulopathy after PH was studied. Compared with MAS, PH resulted in significantly elevated levels of thrombin-antithrombin-lll and plasmin-alpha2-antiplasmin complexes. Levels of antithrombin-3, alpha2-antiplasmin, fibrinogen, plasminogen, alpha2-macroglobulin (alpha2-M), and C1-inhibitor remained lower following PH. Treatment with rBPI(21) led to significantly lower levels of tissue-type plasminogen activator (t-PA). Post-operative disseminated intravascular coagulation (DIC) was associated with significantly higher bilirubin and t-PA plasma levels and significantly lower levels of alpha2-M. This study indicates that PH induced hepatic failure results in decreased synthesis of hepatic regulating plasma proteins and subsequent activation of coagulation and fibrinolysis. Prevention of t-PA release by rBPI(21) may have important clinical implications. Decreased availability of alpha2-M may be a factor in post-operative DIG.

Original languageEnglish
Pages (from-to)261-271
Number of pages11
JournalShock
Volume15
Issue number4
Publication statusPublished - Apr-2001

    Keywords

  • partial hepatectomy, hepatic failure, endotoxin, hepatic synthesis, coagulation and fibrinolytic pathway, disseminated intravascular coagulation, ACUTE-PHASE RESPONSE, DISSEMINATED INTRAVASCULAR COAGULATION, PERMEABILITY-INCREASING PROTEIN, TUMOR-NECROSIS-FACTOR, PLASMINOGEN-ACTIVATOR, INFLAMMATORY RESPONSE, HEPATIC-FAILURE, PLASMA-LEVELS, INTERLEUKIN-6, HEPATECTOMY

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