title: Coagulation profile in patients undergoing video-assisted thoracoscopic lobectomy: A randomized, controlled trial.
abstract: BACKGROUND
  Knowledge about the impact of Low-Molecular-Weight Heparin (LMWH) on the coagulation system in patients undergoing minimal invasive lung cancer surgery is sparse. The aim of this study was to assess the effect of LMWH on the coagulation system in patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.
  
  
  METHODS
  Sixty-three patients diagnosed with primary lung cancer undergoing VATS lobectomy were randomized to either subcutaneous injection with dalteparin (Fragmin®) 5000 IE once daily or no intervention. Coagulation was assessed pre-, peri-, and the first two days postoperatively by standard coagulation blood test, thromboelastometry (ROTEM®) and thrombin generation.
  
  
  RESULTS
  Patients undergoing potential curative surgery for lung cancer were not hypercoagulable preoperatively. There was no statistically significant difference in the majority of the assessed coagulation parameters after LMWH, except that the no intervention group had a higher peak thrombin and a shorter INTEM clotting time on the first postoperative day and a lower fibrinogen level on the second postoperative day. A lower level of fibrin d-dimer in the LMWH group was found on the 1. and 2.postoperative day, although not statistical significant. No differences were found between the two groups in the amount of bleeding or number of thromboembolic events.
  
  
  CONCLUSIONS
  Use of LMWH administered once daily as thromboprophylaxis did not alter the coagulation profile per se. As the present study primarily evaluated biochemical endpoints, further studies using clinical endpoints are needed in regards of an optimized thromboprophylaxis approach.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Thomas Decker
authors.identifier: http://orcid.org/0000-0001-6509-8510
authors.initials: TD
authors.lastname: Christensen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Vad
authors.affiliation: Department of Anesthesiology and Intensive Care & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Pedersen
authors.affiliation: Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Kåre
authors.initials: K
authors.lastname: Hornbech
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Nora Elisabeth
authors.initials: NE
authors.lastname: Zois
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Licht
authors.affiliation: Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Nybo
authors.affiliation: Department of Clinical Biochemistry & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Anne-Mette
authors.initials: AM
authors.lastname: Hvas
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000032:analysis; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011184:Postoperative Period; D020775:Thoracic Surgery, Video-Assisted; D013917:Thrombin / Q000378:metabolism; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D; D005340:Fibrinogen; D013917:Thrombin