The thrombodynamics test as a new opportunity for a polyclinic surgeon to monitor postoperative venous thromboembolic complications

Abstract

Introduction. Postoperative venous thromboembolic complications – a frequent and difficult to control problem for a polyclinic surgeon. Aim. To study and evaluate the possibilities of using the thrombodynamics test for the control of postoperative venous thromboembolic complications. Materials and methods. In 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias and varicose veins of the lower extremities), who underwent planned surgical treatment, stratified into risk groups of postoperative venous thromboembolic complications: low, moderate and high, in the postoperative period for 2–3, 7–9, 14–16, 30 days, a study of D-dimer, thrombodynamics test was conducted in parallel with ultrasound examination of the veins of the lower extremities. Results. It was revealed that hypercoagulation according to the thrombodynamics test was present in 34.2% of patients already at the first study, an increase in D-dimer was noted in 28.3% of patients at late follow-up, venous thrombosis was detected on ultrasound in 15% of the studied 6 people from each risk group within 2–15 days after surgery, carried in 83.3% The cases were asymptomatic, localized mainly in the deep veins of the lower leg and were always combined with hypercoagulation according to the thrombodynamics test and an increased level of D-dimer. It was noted that hypercoagulation against the background of the use of standard doses of anticoagulants in 61% of cases takes a positive trend, and in 39% remains unchanged. Discussion. Hypercoagulation recorded by the thrombodynamics test in the first days after surgery indicates insufficient effectiveness ofstandard thromboprophylaxis in the perioperative period. An increase in the D-dimer cannot be used as a prognosis of a prethrombotic state. Conclusions. Hypercoagulation as a precursor of venous thrombosis is well detected by the thrombodynamics test, its dynamics reflects the individual effectiveness of the use of anticoagulants, which justifies the possibility of using this indicator by a polyclinic surgeon in the control of postoperative venous thromboembolic complications.

Keywords

• postoperative venous thromboembolic complications
• thrombodynamics test
• outpatient surgery
• hypercoagulation
• pharmacothromboprophylaxis