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The Cause of Coagulopathy After Peritoneovenous Shunt for Malignant Ascites

The Cause of Coagulopathy After Peritoneovenous Shunt for Malignant Ascites Abstract • Thirty-five patients with malignant ascites who received a peritoneovenous shunt were studied to determine the type and duration of postoperative coagulopathy. Coagulation factors were measured before and on the first and third day after the placement of a Denver peritoneovenous shunt; 1 to 10 L of ascites was removed at operation. Levels of platelets, antithrombin III, plasminogen, antiplasmin, fibrinogen, and factors V and VIII decreased by the first postoperative day but did not change further through the third day. The levels of fibrinolytic split products increased on day 1 but were lower by day 3. The platelet count reduction by the third day correlated with the hematocrit change (-0.031). The prothrombin and activated partial thromboplastin times remained normal postoperatively. The patterns of change were similar for patients with positive (n=18) and negative (n = 17) ascites cytologic findings, with elevated (n = 24) and normal (n = 11) preoperative fibrinolytic split product levels, an elevated bilirubin value (25 μmol/L; n=9), and no jaundice (n = 26). Bleeding did not occur. The data indicated that plasminogen- rather than thromboplastin-activated fibrinolysis occurred and that platelet reduction was largely dilutional. The reactions were not progressive when ascites was removed operatively. (Arch Surg. 1990;125:474-477) References 1. Schwartz ML, Swaim WR, Vogel SB. Coagulopathy following peritoneovenous shunting . Surgery . 1979;85:671-676. 2. Ragni MV, Lewis JH, Spero JA. Ascites-induced LeVeen shunt coagulopathy . Ann Surg . 1983;198:91-95.Crossref 3. Gleysteen JJ, Klamer TW. Peritoneovenous shunts: predictive factors of early treatment failure . Am J Gastroenterol . 1984;79:654-658. 4. Harmon DC, Demirjian A, Ellman L, Fischer JE. Disseminated intravascular coagulation with the peritoneovenous shunt . Ann Intern Med . 1979;90:774-776.Crossref 5. Tawes RL, Sydorak GR, Kennedy PA, et al. Coagulopathy associated with peritoneovenous shunting . Am J Surg . 1981;142:51-55.Crossref 6. Reinhold RB, Lokich JJ, Tomashefski J, Costello P. Management of malignant ascites with peritoneovenous shunting . Am J Surg . 1983;145:455-457.Crossref 7. Qazi R, Savlov ED. Peritoneovenous shunt for palliation of malignant ascites . Cancer . 1982;49:600-602.Crossref 8. Kostroff KM, Ross DW, Davis JM. Peritoneovenous shunting for cirrhotic versus malignant ascites . Surg Gynecol Obstet . 1985;161:204-208. 9. LeVeen HH, Ahmed N, Hutto RB, Moon IP, LeVeen EG. Coagulopathy post peritoneovenous shunt . Ann Surg . 1987;205:305-311.Crossref 10. Clauss A. Gerinnungs physiologisch Schnellmethode zur Bestinnung des Fibrinogens . Acta Haematol (Basel) . 1957;17:237-246.Crossref 11. Stein SF, Fulenwider JT, Ansley JD, et al. Accelerated fibrinogen and platelet destruction after peritoneovenous shunting . Arch Intern Med . 1981; 141:1149-1151.Crossref 12. Hafter R, Klaubert W, Gollwitzer R, vonHugo R, Graeff H. Crosslinked fibrin derivatives and fibronectin in ascitic fluid from patients with ovarian cancer compared to ascitic fluid in liver cirrhosis . Thromb Res . 1984;35:53-64.Crossref 13. Patrassi GM, Martinelli S, Sturniolo GC, Capellato MG, Vicariotto M, Girolami A. Fibrinolytic study in plasma and ascitic fluid of cirrhotic patients before and after ascites concentration: reinfusion technique . Eur J Clin Invest . 1985;15:161-165.Crossref 14. Henderson JM, Stein SF, Kutner M, Wiles M, Ansley JD, Rucman D. Analysis of twenty-three plasma proteins in ascites . Ann Surg . 1980;192:738-742.Crossref 15. Porter JM, Ball AP, Silver D. Mesothelial fibrinolysis . J Thorac Cardiovasc Surg . 1971;62:725-730. 16. Kernoff PBA, McNichol GP. Normal and abnormal fibrinolysis . Br Med Bull . 1977;33:239-243. 17. Bennett B, Ogsten D. Fibrinolytic bleeding syndromes . In: Ratnoff OD, Forbes CD, eds. Disorders of Hemostasis . New York, NY: Grune & Stratton; 1984:321-349. 18. Salem HH, Dudley FJ, Merrett A, Perken J, Firk BG Coagulopathy of peritoneovenous shunts: studies on the pathogenic role of ascitic fluid collagen and value of antiplatelet therapy . Gut . 1983;24:412-417.Crossref 19. Buller HR, ten Cate JW. Antithrombin III infusion in patients undergoing peritoneovenous shunt operation: failure in the prevention of disseminated intravascular coagulation . Thromb Haemost . 1983;49:128-131. 20. Rodyznek JJ, Urbain D, Leautaud P, Wettendorff P, Delcourt A. Antithrombin III, plasminogen and alpha-2 antiplasmin in jaundice: clinical usefulness and prognostic significance . Gut . 1984;25:1050-1056.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Cause of Coagulopathy After Peritoneovenous Shunt for Malignant Ascites

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References (21)

Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1990.01410160060013
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Abstract

Abstract • Thirty-five patients with malignant ascites who received a peritoneovenous shunt were studied to determine the type and duration of postoperative coagulopathy. Coagulation factors were measured before and on the first and third day after the placement of a Denver peritoneovenous shunt; 1 to 10 L of ascites was removed at operation. Levels of platelets, antithrombin III, plasminogen, antiplasmin, fibrinogen, and factors V and VIII decreased by the first postoperative day but did not change further through the third day. The levels of fibrinolytic split products increased on day 1 but were lower by day 3. The platelet count reduction by the third day correlated with the hematocrit change (-0.031). The prothrombin and activated partial thromboplastin times remained normal postoperatively. The patterns of change were similar for patients with positive (n=18) and negative (n = 17) ascites cytologic findings, with elevated (n = 24) and normal (n = 11) preoperative fibrinolytic split product levels, an elevated bilirubin value (25 μmol/L; n=9), and no jaundice (n = 26). Bleeding did not occur. The data indicated that plasminogen- rather than thromboplastin-activated fibrinolysis occurred and that platelet reduction was largely dilutional. The reactions were not progressive when ascites was removed operatively. (Arch Surg. 1990;125:474-477) References 1. Schwartz ML, Swaim WR, Vogel SB. Coagulopathy following peritoneovenous shunting . Surgery . 1979;85:671-676. 2. Ragni MV, Lewis JH, Spero JA. Ascites-induced LeVeen shunt coagulopathy . Ann Surg . 1983;198:91-95.Crossref 3. Gleysteen JJ, Klamer TW. Peritoneovenous shunts: predictive factors of early treatment failure . Am J Gastroenterol . 1984;79:654-658. 4. Harmon DC, Demirjian A, Ellman L, Fischer JE. Disseminated intravascular coagulation with the peritoneovenous shunt . Ann Intern Med . 1979;90:774-776.Crossref 5. Tawes RL, Sydorak GR, Kennedy PA, et al. Coagulopathy associated with peritoneovenous shunting . Am J Surg . 1981;142:51-55.Crossref 6. Reinhold RB, Lokich JJ, Tomashefski J, Costello P. Management of malignant ascites with peritoneovenous shunting . Am J Surg . 1983;145:455-457.Crossref 7. Qazi R, Savlov ED. Peritoneovenous shunt for palliation of malignant ascites . Cancer . 1982;49:600-602.Crossref 8. Kostroff KM, Ross DW, Davis JM. Peritoneovenous shunting for cirrhotic versus malignant ascites . Surg Gynecol Obstet . 1985;161:204-208. 9. LeVeen HH, Ahmed N, Hutto RB, Moon IP, LeVeen EG. Coagulopathy post peritoneovenous shunt . Ann Surg . 1987;205:305-311.Crossref 10. Clauss A. Gerinnungs physiologisch Schnellmethode zur Bestinnung des Fibrinogens . Acta Haematol (Basel) . 1957;17:237-246.Crossref 11. Stein SF, Fulenwider JT, Ansley JD, et al. Accelerated fibrinogen and platelet destruction after peritoneovenous shunting . Arch Intern Med . 1981; 141:1149-1151.Crossref 12. Hafter R, Klaubert W, Gollwitzer R, vonHugo R, Graeff H. Crosslinked fibrin derivatives and fibronectin in ascitic fluid from patients with ovarian cancer compared to ascitic fluid in liver cirrhosis . Thromb Res . 1984;35:53-64.Crossref 13. Patrassi GM, Martinelli S, Sturniolo GC, Capellato MG, Vicariotto M, Girolami A. Fibrinolytic study in plasma and ascitic fluid of cirrhotic patients before and after ascites concentration: reinfusion technique . Eur J Clin Invest . 1985;15:161-165.Crossref 14. Henderson JM, Stein SF, Kutner M, Wiles M, Ansley JD, Rucman D. Analysis of twenty-three plasma proteins in ascites . Ann Surg . 1980;192:738-742.Crossref 15. Porter JM, Ball AP, Silver D. Mesothelial fibrinolysis . J Thorac Cardiovasc Surg . 1971;62:725-730. 16. Kernoff PBA, McNichol GP. Normal and abnormal fibrinolysis . Br Med Bull . 1977;33:239-243. 17. Bennett B, Ogsten D. Fibrinolytic bleeding syndromes . In: Ratnoff OD, Forbes CD, eds. Disorders of Hemostasis . New York, NY: Grune & Stratton; 1984:321-349. 18. Salem HH, Dudley FJ, Merrett A, Perken J, Firk BG Coagulopathy of peritoneovenous shunts: studies on the pathogenic role of ascitic fluid collagen and value of antiplatelet therapy . Gut . 1983;24:412-417.Crossref 19. Buller HR, ten Cate JW. Antithrombin III infusion in patients undergoing peritoneovenous shunt operation: failure in the prevention of disseminated intravascular coagulation . Thromb Haemost . 1983;49:128-131. 20. Rodyznek JJ, Urbain D, Leautaud P, Wettendorff P, Delcourt A. Antithrombin III, plasminogen and alpha-2 antiplasmin in jaundice: clinical usefulness and prognostic significance . Gut . 1984;25:1050-1056.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Apr 1, 1990

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