Alterations in the Coagulation System during Major Visceral Surgery in Children.
Purpose. The description of the alterations in the hemostatic system in children undergoing abdominal surgery is sparse. Enhanced clinical outcomes for previously untreatable conditions have led to an increased incidence of venous thromboembolic complications. Alterations in children's coagulation system during major abdominal operations compared to minor procedures were examined. Methods. Children (0-12 years) undergoing either laparotomy, thoracotomy, or minor surgery were included. Participants were divided into two groups: group 1 was open laparotomy including operations for solid abdominal tumours and thoracotomy, while group 2 was minor surgery. Activated partial thromboplastin time (aPTT), D-dimer, INR, and fibrinogen were measured. Results. Both groups had a shorter aPTT, higher INR, and lower fibrinogen concentrations after the operation, while D-dimer was unaltered. The changes were, however, discrete and probably not clinically significant. On day 3, all parameters except aPTT in group 1 (not measured in group 2) indicated a continuous coagulation activity. Conclusion. The tendency for coagulation activity altered based on the length and degree of surgery. A continuously altered activity was observed compatible with the reported increased risk of venous thromboembolism at day 3. However, before introducing thromboprophylaxis guidelines larger series of multicentre studies are needed.
Department of Surgery, Odense University Hospital, 5000 Odense C, Denmark ; Department of Orthopaedic Surgery, Vejle Hospital, Kabbeltoft 25, 7100 Vejle, Denmark.
Hayarpi H
HH
Kordjian
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, 5000 Odense C, Denmark.
Mads
M
Nybo
Department of Surgery, Odense University Hospital, 5000 Odense C, Denmark.
Niels
N
Qvist