Changes in haemostasis after laparoscopic surgery in gynaecology: Contribution of the thrombin generation test

Surgery induces immediate hypercoagulability by direct alteration of the va scular bed, release of procoagulant substances from the extravascular space s and blood flow decrease, and delayed hypercoagulation in response to tiss ue damage which triggers inflammatory responses. Thus, the postoperative pe riod represents a high-risk time for thrombosis. Recognition of high-risk i ndividuals would make it possible to improve thromboembolism prevention. We studied in women undergoing laparoscopic surgery a series of markers known to be related to the thrombotic risk and confronted their results with tho se of a global test, the thrombin generation test (TGT) described by Hemker 's group. Our results show that two groups of patients can be distinguished according to usual risk markers (PAI-1, TAT, body mass index): the higher risk group demonstrates higher initial TGT values, but also a postoperative decrease of the TGT values whose mechanisms remain to be defined. Copyrigh t (C) 2001 S. Karger AG, Basel.