Increased von Willebrand Factor to ADAMTS13 ratio as a predictor of thrombotic complications following a major hepatectomy.

OBJECTIVE To investigate the association between changes in procoagulant/fibrinolytic factors and thrombotic complications following a major hepatectomy. Little information is available regarding the changes in procoagulant/fibrinolytic factors (such as the von Willebrand factor [vWF] and a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 [ADAMTS13]), following a major hepatectomy. DESIGN Patients who underwent a major hepatectomy from 2010 to 2011 were enrolled. Patients who underwent a pancreatoduodenectomy (PD) during the same period were also observed as controls, for whom operation time and amount of intraoperative blood loss were comparable to those of the patients who underwent a major hepatectomy. Blood samples were prospectively collected to measure various procoagulant/fibrinolytic factors, including vWF and ADAMTS13. SETTING Nagoya University Hospital, Japan. PATIENTS A total of 50 patients who underwent a major hepatectomy and a total of 23 patients who underwent a PD. RESULTS The levels of vWF in the patients who underwent a major hepatectomy increased from before the operation to the seventh postoperative day and were significantly higher than those observed in the patients who underwent a PD. The ADAMTS13 activity in the patients who underwent a major hepatectomy gradually decreased throughout the first 14 postoperative days. In contrast, ADAMTS13 activity in the patients who underwent a PD returned to nearly normal levels within 2 weeks. Three patients who underwent a major hepatectomy had clinically significant thrombotic complications within the first 2 weeks after surgery; however, none of the patients who underwent a PD had thrombotic complications. The vWF to ADAMTS13 ratios of the 3 patients who experienced thrombotic complications were extremely high even before the occurrence of complications. No other procoagulant/fibrinolytic factors showed a marked association with thrombotic events. The vWF to ADAMTS13 ratio was significantly correlated with the estimated liver remnant volume (P < .001) but not with other preoperative or intraoperative factors. CONCLUSIONS The vWF to ADAMTS13 ratio may be a potentially useful marker in predicting thrombotic complications following a major hepatectomy.