Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy.
BACKGROUND
Venous thromboembolism is a relevant social and health care problem because of its high incidence among patients who undergo surgery (20-30% after general surgical operations and 50-75% after orthopedic procedures), its pulmonary embolism-related mortality rate, and its long-term sequelae (postthrombotic syndrome and ulceration), which may be disabling. This study aimed to determine the coagulation status and the presence of postoperative deep vein thrombosis (DVT) in patients undergoing laparoscopic (LC) and open cholecystectomy (OC).


METHODS
Prospectively, 114 patients were randomized into two groups. group 1 (58 patients undergoing LC) and group 2 (56 patients who are undergoing OC). The coagulation parameters (prothrombin time [PT], partial thromboplastin time [PTT], D-dimer, prothrombin F1 + 2, antithrombin III, and factor VII) were monitored preoperatively and during the operation, then 24 and 72 h after the operation. The patients in both groups underwent color duplex scan examination preoperatively, then 3 and 7 days after surgery to establish the presence of DVT. None of the patients in either group received thrombosis prophylaxis.


RESULTS
In the LC group, postoperative DVT developed in four patients (6.9%; in the calf veins of 3 patients and in the popliteal vein of 1 patient). In the OC group, nine patients (16.07%) had postoperative DVT (in the calf veins of 7 patients and in the popliteal and femoral veins of 2 patients). The plasma levels of monitored parameters in the patients of both groups were altered, but the difference between the groups was not statistically significant. For the patients in both groups who experienced DVT, only the decrease of factor VII had statistical significance (p < 0.05).


CONCLUSIONS
The incidence of postoperative DVT among the patients who underwent OC was higher than among the patients who underwent LC (p < 0.05). The decrease in factor VII among the patients who underwent surgery could be a potentially useful parameter indicating the patients at high risk for developing DVT.
Milic
D J
DJ
Surgical Clinic, Clinical Centre of Nis, Bulevar Z. Djindjica 48, 18 000, Nis, Serbia. dmilic@ptt.yu
Pejcic
V D
VD
Zivic
S S
SS
Jovanovic
S Z
SZ
Stanojkovic
Z A
ZA
Jankovic
R J
RJ
Pecic
V M
VM
Nestorovic
M D
MD
Jankovic
I D
ID
D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000032:analysis*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000097:blood*; D011516:Prothrombin / Q000032:analysis; D020246:Venous Thrombosis / Q000097:blood* / Q000209:etiology
D001779:Blood Coagulation Factors; D000990:Antithrombin III; D011516:Prothrombin