Venous thromboembolism in common laparoscopic abdominal surgical operations

Alizadeh, Reza; Sujatha-Bhaskar, Sarath; Li, Shiri; Stamos, Michael J.; Nguyen, Ninh T.

doi:10.1016/j.amjsurg.2017.08.032

Cited by 22 publications

(11 citation statements)

References 21 publications

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“…The rates of symptomatic VTE (0.3%) and post‐operative bleeding (2.4%) in our cohort are comparable to international studies 14–23 . Importantly, our findings reflect those seen in patients who have undergone hip arthroplasty and spinal surgery, 11,12 that when compared with early chemoprophylaxis, its post‐operative use is associated with a lower risk of bleeding without compromising protection against thromboembolism.…”

Section: Discussionsupporting

confidence: 83%

Pre‐operative and intra‐operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study

Liu

Stevens

Wong

et al. 2020

ANZ Journal of Surgery

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Background: Cholecystectomy is commonly performed in general surgery. Despite guidelines recommending chemical thromboprophylaxis in the perioperative period, the most appropriate time for its initiation is unknown. Here, we investigated whether timing of chemoprophylaxis affected venous thromboembolism (VTE) and bleeding rates postcholecystectomy. Methods: Retrospective review of all elective cholecystectomies performed between 1 January 2018 and 30 June 2019, across seven Victorian hospitals. Clinical VTE was defined as imaging-proven symptomatic disease within 30 days of surgery. Major bleeding was defined as the need for blood transfusion, surgical intervention or >20 g/L fall in haemoglobin from baseline. Results: A total of 1744 cases were reviewed. Chemoprophylaxis was given early (pre-or intra-operatively), post-operatively or not given in 847 (48.6%), 573 (32.9%) and 324 (18.6%) patients, respectively. This varied significantly between surgeons, fellows, trainees and institutions. Clinical VTE occurred in 5 (0.3%) patients and was not associated with chemoprophylaxis timing. Bleeding occurred in 42 (2.4%) patients. Of this, half were major events, requiring surgical control in 5 (11.9%) patients and blood transfusion in 9 (21.4%) patients. Bleeding also extended length of stay (mean (SD), 3.1 (4.0) versus 1.4 (2.2) days, P < 0.001). One bleeding-related mortality was recorded. Importantly, when compared with post-operative (risk ratio 1.46, 95% confidence interval 1.21-1.62) and no (RR 1.23, 95% CI 1.03-1.35) chemoprophylaxis, early usage significantly increased bleeding risk and independently predicted its occurrence. Conclusions: Perioperative chemoprophylaxis is variable among patients undergoing elective cholecystectomy. The rate of clinical VTE post-cholecystectomy is low. Early chemoprophylaxis increases bleeding risk without an appreciable additional protection from VTE.

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Section: Discussionsupporting

confidence: 83%

Pre‐operative and intra‐operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study

Liu

Stevens

Wong

et al. 2020

ANZ Journal of Surgery

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“…Our findings have practical implications for the prevention of VTE after bariatric surgery. By using a simple weight‐adjusted, once‐daily tinzaparin‐based VTE prophylaxis protocol, we demonstrated postoperative VTE rates that appear similar to or lower than those in cohort studies in which weight‐based dosing was not used . The feasibility and efficacy of pharmacologic prophylaxis extended out of hospital have also been demonstrated in other high‐risk patient groups, including medical inpatients and colorectal cancer surgery .…”

Section: Discussionmentioning

confidence: 60%

Weight‐adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery

Tseng

Kolesar

Handa

et al. 2018

Journal of Thrombosis and Haemostasis

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Background Patients undergoing bariatric surgery are at moderate to high risk of venous thromboembolism (VTE). The optimal dose and duration of anticoagulant prophylaxis is uncertain. Objective To evaluate the safety of extended-duration weight-adjusted tinzaparin after bariatric surgery. Patients/methods We conducted a single-center retrospective cohort study of consecutive patients undergoing bariatric surgery who received weight-adjusted tinzaparin 4500-14 000 IU daily (75 IU kg rounded to the nearest prefilled syringe) for 10 days after surgery (7-9 days post-hospital discharge). Primary safety outcomes were the frequency of VTE and major bleeding within 30 days of surgery in patients receiving at least one dose of tinzaparin. Results A total of 1279 patients undergoing bariatric surgery between July 2009 and December 2012 were reviewed, of whom 1212 received weight-adjusted tinzaparin. Safety outcomes were collected for 819 patients at 30 days, and for 1212 patients in-hospital only. The median age was 45.0 years, median weight was 130.0 kg and 98.8% of patients underwent gastric bypass or sleeve gastrectomy. In patients completing 30 days of follow-up, VTE occurred in 4/819 (0.5%) and major bleeding occurred in 13/819 patients (1.6%). In-hospital rates of VTE and major bleeding during surgical admission were 3/1212 (0.2%) and 22/1212 (1.8%), respectively. Conclusions Extended thromboprophylaxis with weight-adjusted tinzaparin appears to be a safe strategy after bariatric surgery, with low rates of postoperative VTE and major bleeding.

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“…8 It was also reported that increased IAP attributed to pneumoperitoneum 1 is associated with thromboembolic events during the postoperative period. 9 During LC, patients are in head-up position, and standard pressure pneumoperitoneum is maintained at 12-14 mmHg by CO 2 insufflation. This high-pressure pneumoperitoneum and head-up position act as risk factors for venous stasis in the lower limbs.…”

Section: Introductionmentioning

confidence: 99%

“…8 It was also reported that increased IAP attributed to pneumoperitoneum is associated with thromboembolic events during the post-operative period. 9…”

Section: Introductionmentioning

confidence: 99%

Effect of obesity on venous hemodynamics of the lower limbs during laparoscopic cholecystectomy

et al. 2022

Phlebology

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Objective The present study aims to compare the changes of venous flow parameters of the lower limbs under the assessment based on the duplex ultrasound scanning in obese and non-obese individuals by complying with body mass index during laparoscopic cholecystectomy. Methods A prospective cohort study was conducted in non-obese (body mass index <25 kg/m2) and obese individuals (body mass index >30 kg/m2) during laparoscopic cholecystectomy to analyze venous hemodynamics of the lower limbs. The assessment was conducted on Femoral vein diameter, Femoral vein cross-sectional area, Femoral vein peak velocity, and Femoral vein volume flow. The change values (%) of venous flow parameters of the lower limbs were calculated as a percentage by: (intra-operative parameter-pre-operative parameter)/ pre-operative parametersX100%. Results 45 right lower limbs were examined in 45 non-obese individuals and 33 right lower limbs in 33 obese individuals during laparoscopic cholecystectomy. The statistically significant difference was identified in the pre-operative and intra-operative values of Femoral vein diameter, Femoral vein cross-sectional area, Femoral vein peak velocity, as well as Femoral vein volume flow in both groups when these were analyzed independently ( p = .00). When the change values of venous flow parameters of the lower limbs of the two groups were compared, more changes were identified significantly in the obese group, Femoral vein diameter ( p = .042), Femoral vein cross-sectional area ( p = .013), Femoral vein peak velocity ( p = .002), and Femoral vein volume flow ( p = .032). Conclusion The changes of lower limb venous flow parameters showed more significant difference in obese than in non-obese individuals during laparoscopic cholecystectomy. The mentioned findings may in part explain why obese patients undergoing laparoscopic cholecystectomy have a higher rate of post op deep venous thrombosis.

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Venous thromboembolism in common laparoscopic abdominal surgical operations

Abstract: Laparoscopic colorectal operations for benign disease is at higher risk for development of VTE compared to other laparoscopic abdominal operations. Further studies should be performed to elucidate the underlying mechanisms for our finding.

Cited by 22 publications

References 21 publications

Pre‐operative and intra‐operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study

Pre‐operative and intra‐operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study

Weight‐adjusted tinzaparin for the prevention of venous thromboembolism after bariatric surgery

Effect of obesity on venous hemodynamics of the lower limbs during laparoscopic cholecystectomy

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