Venous thromboembolism in laparoscopic surgery: experience in elderly
© Compagna et al; licensee BioMed Central Ltd. 2013
Published: 16 September 2013
In the last years venous thromboembolism has became one of the most relevant social and health care problem due to: high incidence among patients who undergo surgery (20–30% after general surgical operations and 50–75% after orthopedic procedures), pulmonary embolism-related mortality rate, and long-term sequelae (postthrombotic syndrome and ulceration). This study has the purpose to establish how patient-related risk factors in elderly (over-70 years old) can modify the effect of laparoscopic cholecystectomy (LC) upon fibrinolysis and coagulation.
This observational study included 90 low-risk elder patients for deep vein thrombosis (DVT) undergoing elective LC, without thromboprophylaxis. Preoperatively and after 24 h, we have evaluated following parameters: FDP, PT-INR, aPTT, d-dimer, fibrinogen. Color Doppler scan of the lower extremity has been performed during first post-operative day. Differences before and after surgery have been evaluated according to risk factors.
We did not appreciate clinically or ultrasound evident DVT. 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 ¼ 0.0001) and FDP positivity exhibited statistically significant increase after surgery. Levels of aPTT did not exhibit any significant change. Regarding d-dimer, elder age has been associated with higher pre-operative concentrations; elderly patients have exhibited higher increase in d-dimer and FDP after surgery. Male sex has been associated with higher PT - INR and aPTT before surgery, as well as with more pronounced increase in PT- INR during post-operative time; at same time elder age has been attributed with higher PT - INR before surgery.
Despite no DVT, we have found significant increase in PT, INR, d-dimer, FDP and fibrinogen after laparoscopic surgery. These data could be the results of surgical trauma and pneumoperitoneum effects on the portal vein flow. Elderly subjects and males show major changes in terms of results.
BA: Associate Professor of Surgery at University “Federico II” of Naples, Italy. RC: Post-graduate Doctorate in Vascular Surgery at University “Federico II” of Naples. GV: Resident in General Surgery Training Programme at University “Federico II” of Naples. TB: Resident in General Surgery Training Programme at University “Federico II” of Naples. MA: Resident in General Surgery Training Programme at University “Federico II” of Naples. RR: Resident in General Surgery Training Programme at University “Federico II” of Naples. FF: Resident in General Surgery Training Programme at University “Federico II” of Naples.
- Dexter SPL, Griffith JP, Grant PJ, McMahon MJ: Activation of coagulation and fibrinolysis in open and laparoscopic cholecystectomy. Surg Endosc. 1996, 10: 1069-1074. 10.1007/s004649900242.View ArticlePubMedGoogle Scholar
- Prisco D, De Gaudio AR, Carla R, Gori AM, Fedi S, Cella AP, Genuini GF, Abbate R: Videolaparoscopic cholecystectomy induces a hemostasis activation of lower grade than does open surgery. Surg Endosc. 2000, 14: 170-174. 10.1007/s004649900093.View ArticlePubMedGoogle Scholar
- Van der Velpen G, Penninckx F, Kerremans R, van Damme J, Arnout J: Interleukin-6 and coagulation-fibrinolysis fluctuations after laparoscopic and conventional cholecystectomy. Surg Endosc. 1994, 8: 1216-1220. 10.1007/BF00591054.View ArticleGoogle Scholar
- Mayol J, Vincent-Hamelin E, Sarmento JM, Oshiro EO, Diaz-Gonzales J, Tamayo FJ, Fdex-represa JA: Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature. Surg Endosc. 1994, 8: 214-217. 10.1007/BF00591834.View ArticlePubMedGoogle Scholar
- Caprini JA, Arcelus JI, Laubach M, Size G, Hoffman KN, Coats RW, Blattner S: Postoperative hypercoagulability and deep vein thrombosis after laparoscopic cholecystectomy. Surg Endosc. 1995, 9: 304-309.PubMedGoogle Scholar
- Patel MI, Hardman DTA, Nicholls D, Fisher CM, Appleberg M: The incidence of deep venous thrombosis after laparoscopic cholecystectomy. Med J Aust. 1996, 164: 652-656.PubMedGoogle Scholar
- Magnusson M, Eriksson BI, Kalebo P, Sivertsson R: Is color Doppler ultrasound a sensitive screening method in diagnosing deep vein thrombosis after hip surgery?. Thromb Haemost. 1996, 75: 242-245.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.