Thrombelastographic evaluation of coagulation in transurethral prostatectomy

Objective To assess the changes in overall coagulation status and define the degree of systemic fibrinolysis occurring in patients undergoing transurethral prostatectomy (TURF). Patients and methods Thirty patients undergoing TURF, 23 for benign prostatic hyperplasia and seven for prostatic carcinoma, were studied prospectively. Serial venous blood samples were taken using the two-syringe technique. Samples were taken before, during and at internals up to 72 h and 10-14 days after surgery. Thrombelastography (TEG) was performed on native whole blood samples. Peri-operative blood loss was assessed, until the catheter was removed, by photometric estimation of the haemoglobin content of the irrigant fluid and the measurement of clot volume. Results There was no evidence of fibrinolysis (TEG Percentage Clot Lysis Ly(60) > 15%) in any patient oner the whole peri-operative period. There was a significant change in the mean TEG variables towards hypercoagulation from 3 h until. 10-14 days postoperatively, compared with the pre-operative values (P < 0.05). There was a significant correlation between blood loss and clot volume. Conclusion These results question the role of systemic fibrinolysis in primary and secondary haemorrhage following TURF and thus the rationale of using antifibrinolytics in these patients. The persistent hypercoagulable state post-operatively indicates a possible role of hypercoagulability in clot retention.