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GENERAL ARTICLES

Prolonged International Normalized Ratio Correlates with a Large Intravascular Fluid Balance After Major Abdominal Surgery

Michal Barak, MD^*¶, Oded Jurim, MD, Ronit Tal, MD, and Yeshayahu Katz, MD, DSc^¶

From the Departments of *Anesthesiology and Surgery B, Rambam Medical Center; Department of Surgery A, Carmel Medical Center; ¶Laboratory for Anesthesia, Pain and Neural Research, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa; Department of Anesthesiology, Haemek Medical Center, Afula, Israel.

Address correspondence and reprint requests to Yeshayahu Katz, MD, DSc, Chairman, Department of Anesthesiology, Haemek Medical Center, Afula 18101, Israel. Address e-mail to ykatz18{at}hotmail.com.

We performed a prospective randomized study of 32 patients who had undergone pancreaticoduodenectomy and did not receive blood during and after surgery. The patients were prospectively assigned to two groups related to fluid balance in the immediate postoperative period. Group 1 (14 patients) were maintained at a positive intravascular fluid balance of 0–1000 mL; Group 2 (18 patients) were maintained at a positive balance of 1000–2000 mL. Complete blood counts and coagulation tests (International Normalized Ratio) and activated partial thromboplastin time (aPTT) were performed at three time points: the day before surgery, on arrival at the postanesthesia care unit, and on leaving the postanesthesia care unit (16 h later). There were significant differences in International Normalized Ratio values between the groups with deterioration during the time they were in the postanesthesia care unit but not in aPTT values. Positive correlation was found between the amount of positive fluid balance and International Normalized Ratio prolongation, but not with aPTT, suggesting that restricted intravascular fluid balance is beneficial for preservation of coagulation after major abdominal surgery.