Discrepancy Between Conventional Coagulation Tests and Thromboelastography During the Early Postoperative Phase of Liver Resection in Neoplastic Patients: A Prospective Study Using the New-Generation TEG®6s

settingsOrder Article Reprints\r\nOpen AccessArticle\r\nDiscrepancy Between Conventional Coagulation Tests and Thromboelastography During the Early Postoperative Phase of Liver Resection in Neoplastic Patients: A Prospective Study Using the New-Generation TEG®6s\r\nby Rita Gaspari 1,2,Paola Aceto 1,2,*ORCID,Simone Carelli 2ORCID,Alfonso Wolfango Avolio 3,4ORCID,Maria Grazia Bocci 5ORCID,Stefania Postorino 2,Giorgia Spinazzola 2,Mariagiovanna Caporale 2,Felice Giuliante 3,6 andMassimo Antonelli 1,2ORCID\r\n1\r\nDepartment of Basic Biotechnological Sciences, Intensive Care Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy\r\n2\r\nDepartment of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy\r\n3\r\nDepartment of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy\r\n4\r\nGeneral Surgery and Transplantation Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy\r\n5\r\nUOC Resuscitation, Istituto Nazionale per le Malattie Infettive L. Spallanzani IRCCS, 00149 Rome, Italy\r\n6\r\nHepatobiliary Surgery Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy\r\n*\r\nAuthor to whom correspondence should be addressed.\r\nJ. Clin. Med. 2025, 14(9), 2866; https://doi.org/10.3390/jcm14092866\r\nSubmission received: 24 March 2025 / Revised: 14 April 2025 / Accepted: 16 April 2025 / Published: 22 April 2025\r\n(This article belongs to the Special Issue Hepatobiliary and Pancreatic Surgery: Diagnosis, Management and Future Opportunities)\r\nDownloadkeyboard_arrow_down Browse Figure Versions Notes\r\nAbstract\r\nBackground: Thromboelastography-6s (TEG®6s), a novel device developed to assess coagulation status, presents advantages such as less frequent calibration, ease of use, and greater stability against movements compared to the previous system (TEG5000). This is the first study in the literature to compare coagulation profiles in the early postoperative period of liver resection (LR) using conventional coagulation tests (CCTs) and TEG®6s. Methods: Forty-six adult patients admitted to the ICU post-surgery after elective LR for malignancy were included. CCTs were used to classify patients into hypocoagulable (HCG) (platelet count < 80 × 109/L, international normalized ratio ≥ 1.4, or activated partial thromboplastin time > 38 s) and normocoagulable (all other cases) groups. Mann–Whitney tests, Spearman’s correlation, and linear regression were used. Results: On ICU admission, nineteen (41.3%) patients had a hypocoagulable profile based on CCTs, but only two (10.5%) of them were rated as hypocoagulable by TEG (p = 0.165). Intraoperatively, HCG patients experienced higher estimated blood loss (EBL) (p = 0.002); they required more fluids (p = 0.019), and more of them received red blood cell transfusions (p = 0.025). They also had higher postoperative arterial lactate levels (p = 0.036). Postoperative 12 h EBL was similar in the two groups (around 150 mL). The ICU stay was longer for HCG group (p = 0.010). Weak associations were observed between TEG/CCTs measures of coagulation initiation [e.g., between R time citrated rapid TEG, and international normalized ratio (r2 = 0.448; p < 0.001)], clot formation [i.e., between conventional fibrinogen value using Clauss method and α-angle citrated rapid TEG (r2 = 0.542; p < 0.001)], and clot strength [e.g., between conventional fibrinogen and citrated kaolin maximum amplitude (r2 = 0.484; p < 0.001)]. Conclusions: CCTs revealed hypocoagulability that was not confirmed by TEG®6s. However, the thromboelastography coagulation profile was more consistent with the detected non-relevant postoperative bleeding.