PERIOPERATIVE PREVENTION OF THROMBOSIS IN PATIENTS WITH HEMOSTASIS DISORDERS

Abstract

The aim of the study is to individualize prevention of thrombosis in abdominal surgery, using assessment of hemostasis functional state. The key sign of hemostasis functional state is the character of the blood clot depends on thromboelastography or electrocoagulography. Medication for prevention of thrombosis may be started over 6 to 8 hours after the end of surgery in hemorrhagic variant of hemostasis subcompensation. In this case anticoagulant of choice is unfractionated heparin given in continuous infusion 100-500 units/hour (1-5 units/kg/hour). As blood clot is stabilized, anticoagulation changeover to low molecular weight heparin, the drug of choice is the dalteparin. In those patients who receive prolonged antithrombotic therapy, length of preoperative bridge therapy may vary, according the structural features of formed clot (based on the electrocoagulography data obtained directly prior to routine anticoagulant injection). In the presence of dense clot (i.e., in thrombotic variant of haemostasis subcompensation) last injection of low molecular weight heparin may be done in 12 hours before surgery without risk of bleeding.

Keywords

• тромбопрофилактика
• абдоминальная хирургия
• геморрагические осложнения