Prophylaxis of venous thromboembolism at surgical treatment of patients with chronic calculous cholecystitis
Objectives. To work out the algorithm of prophylactic anticoagulant dose choice to prevent the venous thromboembolism (VTE) in patients with chronic calculous cholecystitis at surgical treatment. Methods. On the basis of the hemostasis system studying, 58 patients of the main group were divided into 3 subgroups. In the first subgroup of patients (16 patients with hyperaggregation and hypercoagulation) were administered the standard prophylactic dose of fragmin 0,2 ml (5000 ME). In the second subgroup of patients (19 patients with hyporaggregation and hyporcoagulation) a half of the standard prophylactic dose of fragmin 0,1 ml (2500 ME) was administered. In the third subgroup of patients (23 patients with hyperaggregation and hyporaggregation of hypercoagulation of thrombocytes and hypercoagulation and hyporcoagulation) the dose of the low molecular weight heparin was administered without taking into consideration the performed analysis of the hemostasis system and all the patients got the standard prophylactic dose of fragmin 0,2 ml (5000 ME). The nearest results of the laparoscopic cholecystectomy in patients of the main group were compared with the results of the surgical treatment in 5468 patients of the control group. Results. Reduction of the thrombocytes aggregation was registered in the patients of the first and second subgroups. In patients of the third subgroup with hyporaggregation of thrombocytes, significant depression of the blood platelet hypofunction was registered. Coagulation hemostasis changes were seen in the first and second subgroups, which were approximating to the readings of healthy subjects. At the same time the readings of the intravascular blood coagulation of SFMC was higher in the patients of the 3 group and the degree of hyporcoagulation was more marked in them. In more than half patients postoperative period was without complications. 2 cases of the intraoperative bleeding from the gallbladder bed were registered in patients of the 3rd group. Hematomas of the postoperative wounds were also revealed in these patients. None of the patients of three subgroups was noticed to develop VTE. Conclusions. Administration of the low molecular weight heparin to prevent VTE after laparoscopic cholecystectomy in patients with hemostasis hypofunction should be half-dosed and with hyperfunction - a full standard dosed.