28 day post-operative persisted hypercoagulability after surgery for benign diseases: a prospective cohort study

Abstract

BackgroundSurgery for benign disease is associated with a low-risk of developing venous thromboembolism (VTE). Despite a relatively low incidence of postoperative VTE in patients after elective cholecystectomy and abdominal hernia repair there are data proving hypercoagulability in the early postoperative period. We focused on assessment of the systemic inflammatory response and coagulation status in these surgical patients after hospital discharge.MethodsProspectively, patients who underwent surgery for benign disease were included. Two hundred sixteen patients were enrolled - 90 patients in laparoscopic cholecystectomy (LC) group and 126 patients in hernia surgery (HS) group. Risk assessment of VTE according to the Caprini risk assessment model was performed in all patients. Prevalence of VTE in postoperative period was observed. Markers of systemic inflammatory response (IL-6, CRP, α-1-acid glycoprotein, transferrin) and coagulation markers (PLT, fibrinogen, prothrombin fragment F1 + 2 and D-dimer) were measured before surgery, on 7–10th postoperative day and on 28–30th postoperative day.ResultsClinically apparent deep vein thrombosis was diagnosed in only one patient - 0.46 %. Statistically significant elevation of inflammatory markers IL-6, CRP and α-1-acid glycoprotein (p < 0.001; all) were proved in both groups of patients on 7–10th postoperative day. Statistically significant elevation of coagulation markers PLT, fibrinogen, prothrombin fragment F1 + 2 and D-dimer (p < 0.001; all) were proved in LC and HS groups on 7–10th postoperative day. No statistical difference was observed in IL-6, CRP and α-1-acid glycoprotein levels a month after surgery as compared with preoperative levels within each group. Statistically significant elevation of fibrinogen and prothrombin fragment F1 + 2 levels (p < 0.001; both) persisted on 28–30th postoperative day in both groups. Persisted elevation of D-dimer levels was proved only in HS group (p < 0.001), not in LC group (p = 0.138), a month after surgery.ConclusionsActivated systemic inflammatory response and hypercoagulable condition were verified in patients after laparoscopic cholecystectomy and hernia surgery after their hospital discharge. Hypercoagulability persisted even a month after surgery. Nevertheless, we observed very low prevalence of clinically apparent VTE in patients with in-hospital postoperative VTE prophylaxis.Trial registrationTrials of the Czech Ministry of Health No. RVO-VFN64165 and NT 13251-4.

Comparison of postoperative plasma D‐dimer levels between patients undergoing laparoscopic resection and conventional open resection for colorectal cancer

“…11 Postoperative elevation of the plasma D-dimer level has been reported after cholecystectomy and hernia repair, even on POD28. 12 In the present study, the plasma D-dimer level was elevated until at least POD7 in most patients who had undergone colorectal surgery, but symptomatic DVT occurred in two patients. However, D-dimer levels on POD1, POD4, and POD7 were significantly lower in patients after laparoscopic surgery than after open surgery.…”

Venous thromboembolism in emergency general surgery patients: a single-centre retrospective cohort study

“…[11][12][13][14] When compared with patients undergoing elective general surgery procedures, our study shows the rate in EGS patients is higher. A prospective cohort study conducted by Ulrych and colleagues 15 examined clinically significant DVTs in 216 elective general surgery patients who either underwent elective laparoscopic cholecystectomy or elective hernia repair. Only 1 patient (0.46%) experienced DVT in that cohort.…”

Changes in D‐dimer concentration after soft tissue and orthopedic surgery in dogs

“…The shortest procedure (ie, neutering) was the only one in which T1 D‐dimer concentration tended to increase over baseline T0 concentration. Conversely, D‐dimer concentration remained elevated for almost a month after open abdominal surgery in man, whereas, in most of our cases, D‐dimer concentration had returned to the reference interval within 24 hours after surgery.…”

“…The main limitations are limited sample size and short‐term follow‐up. D‐dimer concentration was measured only immediately and 24 hours after surgery, whereas these concentrations remain elevated for weeks after surgery in man . It would, however, be interesting to follow dogs after surgery for a longer period because plasma D‐dimer concentrations were not increased shortly after surgery, thus are unlikely to do so thereafter.…”

“…Postoperative increases in D‐dimer concentration are difficult to interpret because this parameter may increase as a result of the surgery per se or, alternatively, due to secondary hemostatic complications (eg, thrombosis or DIC). In man, multiple studies have evaluated the changes in D‐dimer concentration after different types of surgical procedures, but limited data have been published regarding dogs.…”