Dynamic functional clot formation in patients undergoing endoscopic mucosal resection

Background and Aim: Electric burns can induce fibrinolytic activity. Endoscopic mucosal resection (EMR) is a minimally invasive technique utilizing electrocautery for resection of dysplastic lesions from the gastrointestinal tract. EMR's main complication is clinically significant postendoscopic bleeding. Currently, no studies have investigated the impact of electrocautery during EMR on the coagulation cascade by viscoelastic hemostatic assay. Methods: Thrombelastometry was performed and plasminogen levels were measured on blood samples taken prior to EMR, within an hour following the procedure and 2 days post-EMR. Data were natural log-transformed and analyzed using repeated-measure analysis of covariance (ANCOVA) accounting for age, sex, body mass index (BMI) and site of EMR. Results: Plasminogen levels decreased post-EMR (P = 0.001) and then increased 2 days post-EMR (P < 0.018). FIBTEM A10 and Maximum Clot Firmness, and EXTEM maximum lysis decreased an hour following EMR (P < 0.05 for all). These three measurements then increased 2 days post-EMR (P < 0.01 for all). There were no significant differences in thrombelastometry or plasminogen measures according to sex, age, BMI, or site of EMR. One patient experienced clinically significant postendoscopic bleeding at one-week post-EMR, with substantially decreased FIBTEM A10 and Maximum Clot Firmness at 2 days post-EMR. Conclusions: Decreased post-EMR plasminogen corresponds with reduced clot firmness and enhanced lysis affecting clot quality, strength, and stability. While further investigation in a larger sample is required to confirm the overall risk of clinically significant postendoscopic bleeding and mechanisms for plasminogen activation; this study highlights the potential utility of thrombelastometry in assessing fibrinolytic activity during EMR.