POSTOPERATIVE HYPERCOAGULABILITY AND DEEP-VEIN THROMBOSIS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Patients who undergo laparoscopic cholecystectomy (LC) are operated on under general anesthesia, in a reverse Trendelenburg position, with 1 2-15-mmHg pneumoperitoneum. All of these factors can induce venous sta sis of the legs, which may lead to postoperative deep-vein thrombosis (DVT). The objectives of this study were to assess the degree of hyper coagulability and to determine the rate of postoperative DVT in a grou p of 100 patients in whom LC was completed. Whole-blood thrombelastogr aphy (TEG) and plasma-activated partial thromboplastin time (PIT) dete rmination were carried out preoperatively and on the Ist postoperative day. All patients received pre-, intra-, and postoperative graduated compression stockings and sequential pneumatic compression devices unt il fully ambulatory. Twenty-six percent of the patients with a risk sc ore >4, or a postoperative TEG index >+5.0, received subcutaneous hepa rin (5,000 units b.i.d.), beginning in the postoperative period and co ntinuing for 4 weeks as an outpatient. A complete venous duplex scan o f both legs was performed on the 7th postoperative day, at the time of their office visit. Our results revealed significant postoperative hy percoagulability for the TEG index (P < 0.005) and for PTT (P < 0.05). One patient had an asymptomatic DVT (Ire), and no side effects from t he mechanical or pharmacological prophylaxis occurred in this series. These data suggest that the low incidence of thrombosis in the face of theoretical and laboratory evidence of postoperative hypercoagulabili ty may reflect an effective prophylactic regime. Alternatively, the in cidence of these thrombotic problems may be very low, or the sensitivi ty and timing of duplex scanning may be inadequate to identify asympto matic venous thrombosis. Until further studies are done to resolve the se issues, we feel that mechanical prophylaxis combined with selective low-dose heparin therapy is safe and effective in patients having lap aroscopic cholecystectomy.