Coagulation following major liver resection–a reply

Abstract

There is no discrepancy with these results and those from the ROTEM viscoelastic tests indicative of the rate and quantity of thrombin generation i.e. clotting time, clot formation time and alpha angle, as these were also within normal range. It was only in the subset of samples performed on postoperative day one, when protac was added to the thrombin generation assays, activating the protein C pathway, that increased thrombin generation was observed. This enhanced thrombin generation appears to be related to the imbalance of pro- to anticoagulant factors. To date, there has been nothing published on the effect of thrombomodulin or protac on viscoelastic haemostatic assays. We agree that this discordance between protac-modified thrombin generation assays, standard thrombin generation assays and viscoelastic testing needs further investigation and is in part a reflection of the complex changes seen in this group of patients.