thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy a prospective cohort study background and objectives cytoreductive surgery crs with hyperthermic intraperitoneal peroperative chemotherapy hipec indicated for patients with peritoneal metastases from digestive or gynecological malignancies alike demonstrates a considerable impact on hemostatic metabolism both on platelet and on coagulation level the potential hemostatic interference in crs and hipec is phase dependent the hypothesis of this prospective cohort study is that the procedure exposed an increased thrombotic risk resulting in a faster and increased thrombin generation and hyper platelet functionmethods this study explores the combined use of rotem rotational thromboelastometry pact platelet activation test and cat thrombin generation test assays during crs and hipec with a followup of 7 days postoperative in 27 patients with confirmed histological diagnosis of peritoneal diseaseresults platelet reactivity relative to before incision values to crp collagenrelated peptide p value 002 and trap thrombin receptor activator peptide p value 0048 seems to be slightly reduced during crs and hipec with regard to iib3 activation while pselectin expression is not affected during surgery cat demonstrates that the lt lagtime p value 00003 and ttp timetothrombin peak values p value 0002 decrease while and the tp thrombin peak p value 0004 and etp endogenous thrombin potential p value 002 increase subsequently after surgery the lt and ttp increase and etp and tp decrease in time rotem extem extrinsic mcf maximum clot firmness p value 0005 intem intrinsic mcf p value 0003 and fibtem fibrinogen mcf p value 0001 decreased during crs at day 7 intem and fibtem mcf values p values of 0004 and 0001 were significantly higher than before surgery no considerable changes in platelet count and hemoglobin concentration and absence of leukopenia are noticedconclusion this approach detects changes in coagulation much earlier than noticed by standard coagulation tests