Coagulation activation after laparoscopic cholecystectomy in spite of thromboembolism prophylaxis

Lindberg, Fredrik; Rasmussen, I; Siegbahn, Agneta; Bergqvist, David

doi:10.1007/s004640000213

Cited by 42 publications

(32 citation statements)

References 17 publications

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“…The present study revealed that no significant changes were observed for PT, APTT and TT; the mean level of antithrombin III was found to be significantly below preoperative values on POD1 and POD2, and the fibrinogen and D-dimer levels were increased continuously during the 7 days following surgery. These results are consistent with previous studies (23,27). It was also observed that the levels of VWF antigen and activity were increased significantly above preoperative levels as the plasma ADAMTS13 and its proteolytic activity decreased continuously from POD1 to POD7.…”

Section: Discussionsupporting

confidence: 82%

“…These clinically significant hemorheological and hemostasiological alterations include: Hyperreagibility of platelets with increased aggregation and adhesion tendency; changes in fibrinogen, albumin and globulin concentrations, which affect viscosity and erythrocyte aggregation and impairment of deformability; increase in clotting factors and disturbance of fibrinolysis (20)(21)(22). Patients undergoing surgical procedures have been subject to investigation, in which thrombin activation parameters, clotting factors, fibrinolysis and thrombelastographic changes were examined in order to determine whether hypercoagulation occurs (23)(24)(25)(26)(27). The present study revealed that no significant changes were observed for PT, APTT and TT; the mean level of antithrombin III was found to be significantly below preoperative values on POD1 and POD2, and the fibrinogen and D-dimer levels were increased continuously during the 7 days following surgery.…”

Section: Discussionmentioning

confidence: 99%

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Changes in von Willebrand factor and ADAMTS-13 in patients following arthroplasty

Liu

Ling

et al. 2014

Molecular Medicine Reports

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Abstract. The glycoprotein, von Willebrand factor (VWF) is a carrier protein for factor VIII. When bound to platelets and the extracellular matrix, it promotes aggregation or adhesion of platelets to areas of vascular damage. A disintegrin and metalloproteinase with thrombospondin motif, member 13 (ADAMTS13) cleaves between the tyr1605 and met1606 residues in the central A2 domain of VWF decreasing its activity. The levels of ADAMTS13 and VWF are positively correlated with the risk of developing thrombosis and inversely correlated with the risk of bleeding. A total of 93 patients were observed, who underwent total hip arthroplasty or total knee arthroplasty. Blood samples were collected preoperatively and on postoperative days (PODs) 1, 2, 3, 5 and 7. Plasma levels of the ADAMTS13 antigen were determined using western blotting. The proteolytic activity was validated with the FRETS-VWF73 assay. VWF:Ag and VWF:RCo activity were measured using an enzyme-linked immunosorbent assay. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), antithrombin III and plasma fibrinogen levels were measured on a Sysmex ® CA500 system with corresponding reagents. D-dimer levels were measured on a STA-R fully automated coagulation analyzer. The results demonstrated that, the levels of VWF antigen and activity in the patient increased from postoperative day (POD) 1. By contrast, the level of the ADAMTS13 antigen and its activity in the patients decreased significantly. Starting on POD1, fibrinogen and D-dimer levels increased. No significant changes were observed in PT, APTT and TT. It was concluded that the ADAMTS13 and VWF levels exhibited a marked association with thrombosis risk. The levels of ADAMTS13 and VWF may be potentially useful as markers for predicting thrombotic complications following arthroplasty and inhibiting the activity of VWF may be a novel prophylaxis to reduce postoperative deep venous thrombosis and pulmonary embolism. IntroductionHemostasis is a physiological host defense mechanism focused on the arrest of bleeding following vascular injury. It preserves vascular integrity and prevents excessive blood loss. Arrest of bleeding requires rapid formation of hemostatic plugs at sites of vascular injury to prevent exsanguination. This depends on a complex series of regulatory pathways that activate the platelets and the coagulation system. By contrast, excessive activation of the coagulation system may lead to thrombosis (1).Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been performed with increasing frequency in previous years. In patients undergoing THA or TKA, different patterns of altered venous hemodynamics and hypercoagulability have been identified, thus the rate of distal deep venous thrombosis (DVT) has increased (2). In addition, the risk of venous thrombosis embolism (VTE) in THA and TKA is among the highest for all surgical procedures (3). VTE can be treated, however when left untreated it may be fatal (4).Thrombosis and hemostasis are dependent ...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Changes in von Willebrand factor and ADAMTS-13 in patients following arthroplasty

Liu

Ling

et al. 2014

Molecular Medicine Reports

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“…It is well-known that surgical trauma activates the coagulation system, and several studies have provided evidence of increased D-dimer, and fibrinogen levels after cholecystectomy [27][28][29]. Ntourakis et al showed in a observational study of 119 Blow risk^VTE patients undergoing elective laparoscopic cholecystectomy that elderly patients (>70 years) not only had a higher concentration of D-dimer preoperatively, but also expressed significantly higher postoperative Ddimer levels on the first day after surgery compared to younger patients [30].…”

Section: Discussionmentioning

confidence: 98%

Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy

Strömberg

Sadr–Azodi

Videhult

et al. 2015

Langenbecks Arch Surg

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“…In the OS group, splenic hilar vessels were ligated conventionally, while these structures were divided close to the splenic parenchyma with an endoscopic vascular stapler or with the LigaSure Vessel Sealing System during LS. Previous studies showed that pneumoperitoneum may cause a hypercoagulable state during laparoscopic surgery [37,38]. Changes in intrabdominal pressure during splenectomy decrease portal vein blood flow and induce stasis [39].…”

Section: Discussionmentioning

confidence: 99%

Thrombosis of the splenoportal axis after splenectomy

Romano

Caprotti

Conti

et al. 2006

Langenbecks Arch Surg

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Coagulation activation after laparoscopic cholecystectomy in spite of thromboembolism prophylaxis

Cited by 42 publications

References 17 publications

Changes in von Willebrand factor and ADAMTS-13 in patients following arthroplasty

Changes in von Willebrand factor and ADAMTS-13 in patients following arthroplasty

Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy

Thrombosis of the splenoportal axis after splenectomy

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