Preoperative methylprednisolone administration maintains coagulation homeostasis in patients undergoing liver resection: Importance of inflammatory cytokine modulation

Carlo Pulitanò, Luca Aldrighetti, Marcella Arru, Renato Finazzi, Marco Catena, Eleonora Guzzetti, Laura Soldini, Laura Comotti, Gianfranco Ferla

Research output: Contribution to journalArticlepeer-review

Abstract

Alterations in hemostatic parameters are a common finding after major hepatic resection. There is growing evidence that inflammation has a significant role in inducing coagulation disarrangement that follows major surgery. To determine whether preoperative methylprednisolone administration has a protective effect against the development of coagulation disorders, we evaluated the effect of preoperative steroids administration on changes in hemostatic parameters and plasma levels of inflammatory cytokines in patients undergoing liver surgery. Seventy-three patients undergoing liver resection were randomized to a steroid group or to a control group. Patients in the steroid group received 500 mg of methylprednisolone preoperatively. Serum levels of coagulation parameters (prothrombin time, platelets, fibrinogen, plasma fibrin degradation products [D-dimer], antithrombin III) and inflammatory mediators (IL-6 and TNF-α) were measured before and immediately after the operation and on postoperative days 1, 2, and 5. Multivariate analysis was performed to identify factors related to the characteristics of the patients and surgery affecting coagulation parameters between the two groups. Decreases in antithrombin III, platelet count and fibrinogen levels, prolongation of prothrombin time, and increases in the plasma fibrin degradation products were significantly suppressed by the administration of methylprednisolone. Cytokines production was also significantly suppressed by the administration of methylprednisolone, and there was significant correlation between plasma levels of cytokines and coagulation alterations. These findings suggest that preoperative methylprednisolone administration inhibits the development of coagulation disarrangements in patients undergoing liver resection, possibly through suppressing the production of inflammatory cytokines.

Original languageEnglish
Pages (from-to)401-405
Number of pages5
JournalShock
Volume28
Issue number4
DOIs
Publication statusPublished - Oct 2007

Keywords

  • Coagulation homeostasis
  • Corticosteroid administration
  • Liver surgery
  • Randomized clinical trial
  • Surgical stress

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Physiology

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