Risk Factors for Post HepatectomyThrombocytopenia and INR Elevation:Implications for Epidural AnalgesiaManagement 

• Hepatic resection is commonly performed for malignant andbenign liver disease. 

• Thoracic epidural analgesia provides effective analgesia andfacilitates recovery, but postoperative thrombocytopenia andINR elevation can complicate epidural catheter managementand raise concern for neuraxial hematoma. 

• We sought to quantify the incidence and severity of theseabnormalities and identify independent perioperative predictorsto guide safer neuraxial management. 

•  

• Retrospective single-center study of adults undergoing liverresection between 2015-2022 (N= 877)

• Primary outcomes included platelets nadir <80×10³/µL andINR >1.5 (≤7 days postop)

• Multivariable logistical regression adjusting for liver functionincluding models incorporating MELD and ALBI scores,patient demographics, and operativecharacteristics/complications

•  

• Affected patients had lower baseline platelets (median 143 vs238x10^3µL) and more blood loss (median 700 vs. 350mL)

• Major surgical resection (OR 2.30; P=0.0034) and greater EBL(OR 1.08; P<0/001) associated with increased risk

• Higher baseline platelets are protective(OR 0.85 per10×10³ µL)

• Major resection was the strongest predictor (OR 3.06; P<0.001)

• Other predictors included ASA III–IV (OR 2.87;P=0.039), youngerage (OR per decade 0.82; P=0.01), lower baseline platelets(P=0.005), and higher baseline INR (P=0.03)

• Longer catheter duration with elevated INR (median 81h vs 65h,P<0.0001)

• No cases of epidural hematomas

• Surgical extent of resection and intraoperative blood losscorrelate with post hepatectomy coagulopathy

• Baselines platelet count, baseline INR and age areindependent predictors of coagulopathy

• Frequent laboratory abnormalities support risk stratifiedapproach to epidural placement, surveillance, and removalafter hepatectomies