Caprini JA, Arcelus JI, Laubach M, Size G, Hoffman KN,
Coats RW 2nd, Blattner S.
Postoperative hypercoagulability and deep-vein thrombosis after laparoscopic
cholecystectomy.
Surg Endosc 1995 Mar;9(3):304-9

Department of Surgery, Glenbrook Hospital, Glenview, IL 60025, USA.

Patients who undergo laparoscopic cholecystectomy (LC) are operated on under
general anesthesia, in a reverse Trendelenburg position, with 12-15-mmHg
pneumoperitoneum. All of these factors can induce venous stasis of the legs,
which may lead to postoperative deep-vein thrombosis (DVT). The objectives of
this study were to assess the degree of hypercoagulability and to determine the
rate of postoperative DVT in a group of 100 patients in whom LC was completed.
Whole-blood thrombelastography (TEG) and plasma-activated partial thromboplastin
time (PTT) determination were carried out preoperatively and on the 1st
postoperative day. All patients received pre-, intra-, and postoperative
graduated compression stockings and sequential pneumatic compression devices
until fully ambulatory. Twenty-six percent of the patients with a risk score > 4,
or a post-operative TEG index > +5.0, received subcutaneous heparin (5,000 units
b.i.d.), beginning in the postoperative period and continuing for 4 weeks as an
outpatient. A complete venous duplex scan of both legs was performed on the 7th
postoperative day, at the time of their office visit. Our results revealed
significant postoperative hypercoagulability for the TEG index (P < 0.005) and
for PTT (P < 0.05). One patient had an asymptomatic DVT (1%), and no side effects
from the 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 hypercoagulability may reflect an effective
prophylactic regime.(ABSTRACT TRUNCATED AT 250 WORDS)