A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy

Okuda, Yasuhisa; Kitajima, Toshimitsu; Egawa, Hirotoshi; Hamaguchi, Shinsuke; Yamaguchi, Shigeki; Yamazaki, Hajime; Ido, Kenichi

doi:10.1007/s00464-001-8191-x

Cited by 17 publications

(12 citation statements)

References 16 publications

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“…There have been studies advocating both mechanical and pharmacological DVT prophylaxis ( London: Royal College of Physicians, 2010 ; Okuda et al, 2002 ), but there have also been other studies suggesting that prophylaxis during LCs is unnecessary ( Agnelli, 2004 ; Blake, Toker & Dunn, 2001 ; Lindberg, Bergqvist & Rasmussen, 1997 ).…”

Section: Introductionmentioning

confidence: 99%

Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?

Dönmez¹,

Uzman

Dogan

et al. 2016

PeerJ

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BackgroundLaparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia.Material and MethodsFifty American Society of Anesthesiologist (ASA) I–III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n = 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups.ResultsPT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24.ConclusionBoth the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis.

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Section: Introductionmentioning

confidence: 99%

Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?

Dönmez¹,

Uzman

Dogan

et al. 2016

PeerJ

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“…Abdominal insufflation and the reverse Trendelenburg position of the patient were shown to enhance venous stasis in the lower limbs [4]. Moreover, hypercoagulability and damage to the vessel may also occur [5–7]. However, despite the potential for the development of DVT our findings suggest that this complication is rare.…”

Section: Discussionmentioning

confidence: 90%

Video laparoscopic surgery: is out‐of‐hospital thromboprophylaxis necessary?

Tincani

Piccoli

Turrini

et al. 2005

Journal of Thrombosis and Haemostasis

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Summary. Despite widespread use of laparoscopic procedures, no adequate data are available to support specific recommendations for venous thromboprophylaxis in patients undergoing laparoscopic surgery. This prospective, randomized trial is the first to be designed to evaluate a regimen of out‐of‐hospital thromboprophylaxis after laparoscopic surgery. Consecutive patients admitted for laparoscopic surgery were considered for the study. The thromboprophylaxis regimen used for each patient was based on a risk score. Possible thromboprophylactic measures included elastic stockings and pre‐ and postoperative Dalteparin or early ambulation. At discharge, patients were randomly allocated either to continue Dalteparin for 1 week, or to receive no further prophylaxis. Patients judged to be at low risk were not randomized. Compression ultrasound of the leg veins was performed in all patients 4 weeks after hospital discharge. Fifty‐three patients, all with acute appendicitis, were judged to be at low risk of deep vein thrombosis and were not included in the randomized study. The remaining 209 patients fell into two groups: 104 patients received postdischarge Dalteparin and 105 patients did not. The incidence of deep vein thrombosis was 0% (0 of 104) vs. 0.95% (one of 105), respectively (P = 1.00). The risk of postdischarge venous thromboembolism is low in patients undergoing laparoscopic surgery who receive in‐hospital thromboprophylaxis. Given this low risk, a clinical trial powered to determine if extending prophylaxis in such patients reduces the risk of clinically apparent deep vein thrombosis would be unfeasibly large.

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“…Jacobs et al (12) reported that sequential gradient intermittent pneumatic compression induced prompt, but short-lived, alterations in fibrinolytic function, and the values quickly reverted to baseline on the termination of compression. Okuda et al (8) reported that the intermittent compression boot did not prevent increased intravascular thrombogenesis and platelet activation through significant increases of plasma Ddimer and β-thromboglobulin after laparoscopic cholecystectomy. Killewich et al (10) also reported that enhanced regional fibrinolysis in the lower extremities could not be detected with the use of external pneumatic compression devices, as measured with the tissue plasminogen activator and plasminogen activator inhibitor-1 activity in common femoral venous blood samples obtained from patients undergoing abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Stasis alone does not cause thrombosis, but the combination of stasis, hypercoagulability, and endothelial damage allows thrombus to develop (2). Some studies demonstrated (3)(4)(5)(6)(7)(8) that laparoscopic cholecystectomy leads to postoperative activation of the coagulation system, which is one of the factors for postoperative thromboembolic complications. These changes can also be present in laparoscopic fundoplications.…”

Section: Introductionmentioning

confidence: 99%

Mažos molekulinės masės heparinų ir kintančios pneumokompresijos kojinių hipokoaguliacinis efektas laparoskopinių fundoplikacijų metu

Kiudelis¹,

Gerbutavičius²,

Gerbutavičienė

et al. 2010

Medicina

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Įvadas. Kojų giliųjų venų trombozė yra sveikatos apsaugos ir socialinė problema. Giliųjų venų trombozė pasireiškia 20–30 proc. ligonių po atvirų pilvo chirurgijos operacijų bei 5–6 proc. ligonių po laparoskopinių pilvo ertmės operacijų. Šio tyrimo tikslas – įvertinti ir palyginti mažos molekulinės masės heparinų (MMMH) ir kintamos pneumokompresijos kojinių galimą hipokoaguliacinį poveikį laparoskopinių fundoplikacijų metu. Tirtųjų kontingentas ir tyrimo metodai. Atlikta atsitiktinių imčių klinikinė studija. Tiriamieji suskirstyti į dvi grupes: pirmos grupės ligoniams laparoskopinės fundoplikacijos metu buvo naudojamos kintamos pneumokompresijos kojinės; antros grupės ligoniams – kintamos pneumokompresijos kojinės operacijos metu plius MMMH, kuris sušvirkštas į poodį 1 val. prieš operaciją. Plazmos protrombino fragmentas F1+2 (F1+2), trombino-antitrombino kompleksas (TAT) – trombogenezės žymenys bei laisvas plazmos audinių kelio faktoriaus inhibitorius (fTFPI) – hipokoaguliacijos žymuo buvo tiriami 1 val. prieš operaciją, operacijos metu ir baigus operaciją. Tyrimo rezultatai. Pirmoje grupėje F1+2 ir TAT koncentracija kraujo plazmoje statistiškai reikšmingai padidėjo operacijos metu bei ją baigus. Antroje grupėje F1+2 ir TAT koncentracija operacijos metu nekito. fTFPI koncentracija kraujo plazmoje statistiškai reikšmingai padidėjo operacijos metu antroje grupėje, o pirmoje grupėje ji nekito. Išvada. MMMH ir kintamos pneumokompresijos kojinės derinys, vartojamas laparoskopinių fundoplikacijų metu, sukėlė hipokoaguliacinį poveikį, kurio nepastebėta naudojant tik kintamas pneumokompresines kojines.

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A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy

Abstract: A combination of low-molecular-weight heparin and intermittent pneumatic compression may be more effective to prevent deep-vein thrombosis in the legs.

Cited by 17 publications

References 16 publications

Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?

Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?

Video laparoscopic surgery: is out‐of‐hospital thromboprophylaxis necessary?

Mažos molekulinės masės heparinų ir kintančios pneumokompresijos kojinių hipokoaguliacinis efektas laparoskopinių fundoplikacijų metu

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