Changes in Haemostasis after Laparoscopic Surgery in Gynaecology: Contribution of the Thrombin Generation Test

Abstract

Surgery induces immediate hypercoagulability by direct alteration of the vascular bed, release of procoagulant substances from the extravascular spaces and blood flow decrease, and delayed hypercoagulation in response to tissue damage which triggers inflammatory responses. Thus, the postoperative period represents a high-risk time for thrombosis. Recognition of high-risk individuals 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 those 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.

Hemostatic response to surgical neutering via ovariectomy and ovariohysterectomy in dogs

“…However, the hypothesis that there would be a difference between dogs undergoing ovariectomy and those undergoing ovariohysterectomy was not supported. The detection of hypercoagulability after surgery is in agreement with results of previous studies 14,26 in humans. However, 2 studies 12,15 conducted to evaluate PT, aPTT, AT concentration, platelet counts, hemograms, fibrin-degradable products, plasminogen concentration, plasmin inhibitor concentration, and tissue plasminogen activator concentration failed to find hypercoagulability in dogs after ovariohysterectomy.…”

Evaluation of inflammatory and hemostatic surgical stress responses in male cats after castration under general anesthesia with or without local anesthesia

“…The addition of local anesthesia to the anesthetic protocol did not attenuate the surgical stress response following castration. The discovery of postoperative hypercoagulability in cats of the present study is consistent with findings in human 23,24 and veterinary patients 2,3,25 from other studies.…”

Cellular, hemostatic, and inflammatory parameters of the surgical stress response in pigs undergoing partial pericardectomy via open thoracotomy or thoracoscopy

“…After 3 h postoperatively, the antithrombin levels increased slightly. This finding is in agreement with several other studies and includes thoracic, open abdominal, and laparoscopic procedures, with minimum values of antithrombin recorded from immediately postoperatively to 24 h after the end of surgery [6,8,12,21,25,29]. The decreased plasma concentration is thought to be attributable to increased consumption of antithrombin, decreased synthesis in the liver, increased degradation by neutrophil elastase [17], or an IL-6-induced increase in capillary permeability allowing antithrombin to pass through the endothelium [21].…”

“…No decrease in protein C, as reported by several human studies [8,28,29], was observed in the current study. This could be attributable to the very low levels of protein C in pig plasma, as compared with human plasma, indicating that this system may not play a role in porcine hemostasis equal in importance to that in humans [27].…”