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• W2017137454 abstract "Introduction: Unresectable hepatic metastases represent a significant clinical challenge in a variety of malignancies. Peripheral hepatic perfusion (PHP) is a minimally invasive regional therapy designed to deliver maximum doses of chemotherapy to the liver while minimizing systemic side effects. Although this procedure has greatly reduced the perioperative morbidity associated with operative hepatic artery perfusion, many patients experience some degree of coagulopathy following PHP. Methods: Between August 2001 and August 2007, 81 patients underwent 220 PHPs with melphalan at a single institution under one of three IRB approved protocols for treatment of metastatic melanoma (n=30), neuroendocrine tumors (n=19), colorectal carcinoma (n=11) or primary hepatic malignancies (n=8). During the procedure, patients were anti-coagulated with heparin to achieve and maintain an ACT level greater than 300 seconds. Before, during and after the procedure, patient blood samples were analyzed in the STAT hematology laboratory for PT, PTT, ACT, and platelet levels. A more comprehensive analysis of coagulation profiles was performed for the most recent 34 patients. Antithrombin III, protein C, protein S, fibrinogen, D-dimer, and thrombin times were assessed at baseline and at regular intervals throughout the procedure. All data were collected prospectively. Results: At baseline, all (97/97) patients had an ACT below 200 sec, as well as a PT within 2 seconds of normal (94/94 pts) and PTT within 5 seconds of normal (91/94) in the majority of patients. At the initiation of veno-venous bypass, patients were anticoagulated with heparin to achieve an ACT above than 280 sec, with a maximum ACT greater than 300 noted in 98 of 99 pts during the course of treatment. At the completion of treatment and heparin reversal with protamine, prolonged PT and PTT were noted in 69 and 79 patients, respectively. All patients received protamine for heparin reversal, with an additional 58 patients receiving cryoprecipitate. Grade 3-4 thrombocytopenia (n=59), anemia (n=40), and hepatotoxicity (n=40) was noted in the immediate post-PHP period for 99 patients treated with the present filtration system. Immediate postoperative coagulopathy was corrected using an average of 2.3 U platelets (range 0-20 U), 0.8 U cryoprecipitate (range 0-2 U) and 3.3 U fresh frozen plasma (range 0-10 U). In the subset of 25 patients who received a more extensive coagulation work up, the majority had normal baseline antithrombin III (n=22), Protein S (n=22), and Protein C (n=21) levels. A single patient had a baseline fibrinogen level below normal. Post-PHP 19/34 patients had a fibrinogen level below normal, correcting with the administration of cryoprecipitate in all but 5 patients. Post-PHP elevation in D-dimer levels and serum thrombin times were seen in all patients, and failed to correct with cryoprecipitate in all 31 patients. Hemorrhagic complications were not observed after any of these 31 treatments. Conclusion: PHP represents a regional therapy modality with greatly improved morbidity and mortality when compared to open hepatic artery infusion. Postoperative coagulopathy, however, remains a common toxicity. The coagulopathy associated with veno-venous bypass is attributable to the consumption of clotting factors during bypass and filtration, but can be managed with close monitoring of coagulation and bypass parameters in addition to replacement of clotting factors." @default.
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• W2017137454 date "2008-02-01" @default.
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• W2017137454 title "QS442. An Analysis of Coagulation Profiles in Patients Undergoing Venous Hemofiltration After Intraarterial Chemotherapterapy for Unresectable Hepatic Malignancies" @default.
• W2017137454 doi "https://doi.org/10.1016/j.jss.2007.12.700" @default.
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