Hysterectomy techniques and their effect on the blood markers of thrombogenicity

Objective The use of laparoscopic surgery appears to reduce patient trauma and permits earlier discharge. However the operation may be longer and the overall effect on coagulation and the risk of thrombosis is not clear. Design We compared the effect on coagulation activation markers (thrombin-a ntithrombin, prothrombin fragments 1+2 and D-dimers) and factors (protein C , antithrombin, fibrinogen and activated protein C resistance) of laparosco pic and open abdominal hysterectomy in 39 women for the week following surg ery. Some of these are well-recognised markers of thrombotic risk. Results We found no evidence to suggest that laparoscopic hysterectomy has a more favourable prothrombotic profile. There were no major differences be tween the surgical options. Conclusions Laparoscopic hysterectomy should be subject to the same rigour of thromboprophylaxis as open abdominal hysterectomy. We did find evidence of a prolonged prothrombotic state beyond the normal period of thromboproph ylaxis in both groups.