QUANTITATIVE CHANGES IN PLATELET COUNTS FOLLOWING MAJOR UROLOGICAL PELVIC-SURGERY

Postperative quantitative changes in platelet counts have been reporte d following various extensive surgical procedures. It is generally acc epted that reactive thrombocytosis at levels less than 1,000,000/mm3 i s a benign condition and is not associated with increased risk of post operative thrombohemorrhagic complications. The role of prophylactic t reatment with platelet inhibitors in these situations is controversial . We assessed retrospectively the timing and the extent of postoperati ve thrombocytosis in 85 consecutive patients following major urologica l pelvic surgery and evaluated its possible clinical significance to h emorrhagic and thromboembolic complications, in view of the coincidenc e of multiple potential risk factors for thromboembolism in these pati ents. 73 (85.9 %) patients demonstrated marked postoperative changes o f platelet counts. In 12 patients (14.1 %) we found only minor fluctua tions in platelet counts throughout the postoperative period. Two dist inct groups of 26 and 47 patients respectively could be identified amo ng these 73 patients, who differed in the rate and extent of changes i n platelet counts. Those fluctuations were characterized by an early d ecrease in platelet levels (mean percentage change of 40 and 60% in gr oups I and II respectively). This was followed by a gradual increase l eading to delayed thrombocytosis (mean percentage change of 225 and 30 5% in groups I and II respectively). Thromboembolic complications were diagnosed in 5 patients. The occurrence of thromboembolism preceded a ny significant increase in platelet counts in all 5 patients. There wa s no correlation between the timing of thromboembolic complications an d timing and extent of the change in platelet count. We conclude that reactive thrombocytosis following major urological pelvic surgery is a frequent innocuous finding and is not associated with hemorrhagic or thromboembolic complications. Based on our findings, prophylactic plat elet inhibitors treatment seems unjustified; however, a comparative ra ndomized study may be necessary to affirm this conclusion.