CONDITION OF THE BLOOD COAGULATION SYSTEM AND RISK OF VENOUS THROMBOSIS AND EMBOLISM IN ACUTE CALCULOUS CHOLECYSTITIS AND ITS COMPLICATIONS

Abstract

Background. Acute calculous cholecystitis (ACC) is one of the most frequent causes of urgent hospitalization in general surgical departments. It is known that the pathways of inflammation and coagulation are closely related. The most striking manifestation of a violation of hemostasis and rheology under the influence of the inflammatory process is the development of hypercoagulation in acute cholecystitis. Aim: determine the condition of the blood coagulation system and assessing the risk of venous thrombosis and embolism (VTE) during treatment of patients with acute calculous cholecystitis and its complications. Materials and methods. The design of the study was retrospective analysis of the results of treatment of 206 patients with acute calculous cholecystitis (ACC) and its complications in the Department of surgery and endoscopy of Postgraduate education faculty, Lviv Danylo Halytsky national medical university (at Municipal non-profit enterprise "1st Territorial medical association of Lviv", St. Panteleimon hospital) for the period 2014-2018. Women predominated – 135 (65.5%). Age distribution of patients ranged 18-90 (average – 60.8±15.83). The length of stay of patients in the hospital ranged 1-41 days. Following forms of ACC were: phlegmonous – 86 (41,7%), gangrenous – 115 (55,8%), perforated – 5 (2,4%) patients. Results. Of the entire cohort, cholecystomy was performed in 190 (92.2%) patients, of which 129 (62.6%) underwent laparoscopic and 61 (29.6%) – conventional. Cholecystectomy lasted from 15 min to 1.5 hours (average duration 65±46.15 min). During the laboratory examination in patients with complicated ACC, coagulation system was studied, in which the presence of normocoagulation was detected in 19.2% of patients, hypocoagulation – in 30.4% and hypercoagulation – in 50.4%. Examination of the hemostasiogram in patients with complicated ACC revealed hypocoagulation with the following parameters: prothrombin time – 17”, prothrombin index – 74.2%, fibrinogen – 2.63 g/L; hypercoagulation with the following indicators: prothrombin time – 6.5”, prothrombin index – 130.2%, fibrinogen – 6.5 g/L. The risk of VTE in the treatment of patients with ACC and its complications was assessed by the J. Caprini scale and found that the vast majority (over 71.8%) of patients have a high and very high risk of thromboembolic complications, namely: low risk – 5.8%; average – 12.6%; high – 45.2%; very high – 36.4%. Conclusion. Hypercoagulation is present in 79.3% of patients with uncomplicated and complicated ACC. The appearance of complications of ACC leads to the development of hypercoagulation in 50.4% of patients. Number of patients with complicated ACC with an extremely high risk of VTE according to J. Caprini scale significantly exceeds (p<0,05) the number without complications and is 52.2%. Inclusion of test for blood D-dimers in the examination protocol and ultrasonographic scanning of the veins of the lower extremities will facilitate the early detection, prevention and treatment of VTE.

Keywords

• acute calculous cholecystitis, forms of cholecystitis, risk of venous thrombosis and embolism