Subclinical activation of coagulation and fibrinolysis in laparoscopic cholecystectomy: do risk factors exist?

PURPOSES

This study examines whether inherent patient-related risk factors (age, gender) modify the effect of laparoscopic cholecystectomy (LC) upon the coagulation and fibrinolysis cascades.

METHODS

This observational study included 119 low-risk for deep vein thrombosis (DVT) patients undergoing elective LC, without thromboprophylaxis. Pre-operatively and 24 h post-operatively we measured PT-INR, aPTT, FDP, d-dimer, and fibrinogen. Color Doppler scan of the lower extremity was performed the 1st post-operative day. Differences before and after surgery were analyzed with respect to risk factors.

RESULTS

No clinically or ultrasound evident DVT was observed. INR (1.04 ± 0.06 vs. 1.12 ± 0.11, p < 0.0001), d-dimer (0.38 ± 0.36 vs. 0.9 ± 0.64, p < 0.0001), plasma fibrinogen (380.8 ± 74.9 vs. 403.8 ± 78.8, p = 0.0001) and FDP positivity exhibited statistically significant increase after surgery. The levels of aPTT did not exhibit any significant change. Concerning d-dimer, older age was associated with higher pre-operative concentrations; older patients accordingly exhibited more intense increase in d-dimer and FDP positivity after surgery. Male sex was associated with higher PT-INR and aPTT before surgery, as well as with more pronounced increase in PT- INR postoperatively; similarly, older age was associated only with higher PT-INR before surgery.

CONCLUSIONS

Despite no DVT, significant increase in PT-INR, d-dimer, FDP and fibrinogen appeared after LC. This may be attributed to surgical trauma and pneumoperitoneum effects on the portal vein flow. Elderly subjects and males seem particularly vulnerable, demonstrating more sizeable changes.