Subclinical activation of coagulation and fibrinolysis in laparoscopic cholecystectomy: Do risk factors exist?

INTERNATIONAL JOURNAL OF SURGERY

卷:9

Article

Ntourakis, Dimitris¹  Sergentanis, Thodoris N.¹  Georgiopoulos, Ioannis¹  Papadopoulou, Eleni²  Liasis, Lambros¹  Kritikos, Emmanuel¹  Tzardis, Periklis¹  Laopodis, Vasilios¹ 

[1] Korgialenio Benakio Hellen Red Cross Hosp, Dept Surg 1, Laparoscopy Unit, Athens 11526, Greece

[2] Korgialenio Benakio Hellen Red Cross Hosp, Dept Radiol, Athens 11526, Greece

关键词: Laparoscopic cholecystectomy;    Coagulation;    Fibrinolysis;    Thrombosis;    DVT;    Deep vein thrombosis;    Risk factors;    d-dimer;    PT;    INR;    aPTT;    Fibrinogen;    Age;    Gender;   

DOI  :  10.1016/j.ijsu.2011.02.011

来源: Elsevier

【 摘 要 】

Purposes: This study examines whether inherent patient-related risk factors (age, gender) modify the effect of laparoscopic cholecystectomy (LC) upon the coagulation and fibrinolysis cascades. Methods: This observational study included 119 low-risk for deep vein thrombosis (DVT) patients under-going elective LC, without thromboprophylaxis. Pre-operatively and 24 h post-operatively we measured PT-INR, aPTT, FDP, d-dimer, and fibrinogen. Color Doppler scan of the lower extremity was performed the 1st post-operative day. Differences before and after surgery were analyzed with respect to risk factors. Results: No clinically or ultrasound evident DVT was observed. INR (1.04 +/- 0.06 vs. 1.12 +/- 0.11, p < 0.0001), d-dimer (0.38 +/- 0.36 vs. 0.9 +/- 0.64, p < 0.0001), plasma fibrinogen (380.8 +/- 74.9 vs. 403.8 +/- 78.8, p 0.0001) and FDP positivity exhibited statistically significant increase after surgery. The levels of aPTT did not exhibit any significant change. Concerning d-dimer, older age was associated with higher pre-operative concentrations; older patients accordingly exhibited more intense increase in d-dimer and FDP positivity after surgery. Male sex was associated with higher PT-INR and aPTT before surgery, as well as with more pronounced increase in PT-INR postoperatively; similarly, older age was associated only with higher PT-INR before surgery. Conclusions: Despite no DVT, significant increase in PT-INR, d-dimer, FDP and fibrinogen appeared after LC. This may be attributed to surgical trauma and pneumoperitoneum effects on the portal vein flow. Elderly subjects and males seem particularly vulnerable, demonstrating more sizeable changes. (C) 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

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