April 1990

The Cause of Coagulopathy After Peritoneovenous Shunt for Malignant Ascites

Author Affiliations

From the Surgical (Dr Gleysteen) and Laboratory (Dr Heckman) Services, Zablocki Veterans Administration Medical Center, Milwaukee, Wis, and the Departments of Surgery (Dr Gleysteen) and Pathology (Dr Hussey), Medical College of Wisconsin, Milwaukee. Dr Gleysteen is now with the Veterans Administration Medical Center, Birmingham, Ala.

Arch Surg. 1990;125(4):474-477. doi:10.1001/archsurg.1990.01410160060013

• 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)