Objective: Obese patients have an increased predisposition to thrombosis and are at a high risk for thrombotic complications associated with bariatric surgeries. This study aimed to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on coagulation parameters in morbidly obese patients. Material and Methods: This prospective study was performed with 40 American Society of Anesthesiologists II-III morbidly obese patients with a body mass index of ≥40 kg/m² who underwent LSG. Anaesthesia was maintained with sevoflurane after anaesthesia induction. Haemoglobin, haematocrit, platelet, D-dimer and fibrinogen levels as well as prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio (INR) were compared in blood samples taken before the operation and at 1, 24 and 48 hours after the operation. In addition, duration of operation, length of hospital stay and the presence of symptomatic thromboembolic complications within 7 days after the operation were examined. Results: A significant increase was observed in PT and INR in all postoperative periods (p<0.001). Although a significant decrease was observed at the 1st hour, a significant increase was observed at the 24th and 48th hours in aPTT postoperatively (p<0.01). Postoperative fibrinogen and D-dimer levels were significantly higher than the preoperative levels (p<0.01). No symptomatic thromboembolic event was observed in any patient in the early postoperative period. Conclusion: In morbidly obese patients undergoing LSG, coagulation parameters are affected in line with the increased risk of thrombosis. Close monitoring of these patients for postoperative thromboembolic complications is important.
Keywords: Bariatric surgery; obesity, morbid; thrombosis; fibrinogen; venous thromboembolism
Amaç: Obez hastaların tromboza yatkınlığı yüksektir ve bariatrik cerrahilerle ilişkili trombotik komplikasyonlar açısından yüksek risk altındadır. Bu çalışma, morbid obez hastalarda laparoskopik sleeve gastrektominin (LSG) koagülasyon parametreleri üzerine etkisini değerlendirmeyi amaçladı. Gereç ve Yöntemler: Bu prospektif çalışma, beden kitle indeksi ≥40 kg/m² olan ve LSG geçiren Amerikan Anestezistler Derneği II-III 40 morbid obez hasta ile yapılmıştır. Hastalarda anestezi indüksiyonu sonrası sevofluran ile anestezi idamesi sağlandı. Operasyon öncesi, operasyon sonrası 1, 24 ve 48. saatlerde alınan kan örneklerinde hemoglobin, hematokrit, platelet, protrombin zamanı [prothrombin time (PT)], aktive parsiyel thromboplastin zamanı [activated partial thromboplastin time (aPTT)], 'international normalised ratio (INR),' D-dimer ve fibrinojen düzeyleri bakılarak karşılaştırıldı. Ayrıca hastalarda ameliyat süresi, hastane yatış süresi ve operasyon sonrası 7 gün içinde semptomatik tromboembolik komplikasyon varlığı incelendi. Bulgular: PT ve INR postoperatif tüm dönemlerde anlamlı artış gözlenmiştir (p<0,001). Postoperatif 1. saatde aPTT'de anlamlı düşme gözlenirken, 24 ve 48. saaatlerde anlamlı artış gözlenmiştir (p<0,01). Ameliyat sonrası fibrinojen ve D-dimer seviyeleri ameliyat öncesi seviyelere göre anlamlı derecede yüksekti (p<0,01). Postoperatif erken dönemde hiçbir hastada semptomatik tromboembolik hadise görülmemiştir. Sonuç: LSG geçiren morbid obez hastalarda, koagülasyon parametreleri artmış tromboz riskiyle uyumlu olarak etkilenmektedir. Operasyon sonrası tromboembolik komplikasyonlar açısından bu hastaların yakından takibi önemlidir.
Anahtar Kelimeler: Bariatrik cerrahi; obezite, morbid; tromboz; fibrinojen; venöz tromboembolizm
- Domi R, Laho H. Anesthetic challenges in the obese patient. J Anesth. 2012;26(5):758-65. [Crossref] [PubMed]
- Hunt BJ. Hemostasis at extremes of body weight. Semin Thromb Hemost. 2018;44(7): 632-9. [Crossref] [PubMed]
- Samuel N, Jalal Q, Gupta A, Mazari F, Vasas P, Balachandra S. Mid-term bariatric surgery outcomes for obese patients: does weight matter? Ann R Coll Surg Engl. 2020;102(1): 54-61. [Crossref] [PubMed] [PMC]
- Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822-32. [Crossref] [PubMed]
- Becattini C, Agnelli G, Manina G, Noya G, Rondelli F. Venous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention. Surg Obes Relat Dis. 2012;8(1):108-15. [Crossref] [PubMed]
- Wang TF, Milligan PE, Wong CA, Deal EN, Thoelke MS, Gage BF. Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. Thromb Haemost. 2014; 111(1):88-93. [Crossref] [PubMed] [PMC]
- Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc Health Risk Manag. 2015;11:461-77. [Crossref] [PubMed] [PMC]
- Sümer I, Topuz U, Alver S, Umutoglu T, Bakan M, Zengin SÜ, et al. Effect of the "Recruitment" maneuver on respiratory mechanics in laparoscopic sleeve gastrectomy surgery. Obes Surg. 2020;30(7):2684-92. [Crossref] [PubMed] [PMC]
- Pösö T, Kesek D, Aroch R, Winsö O. Morbid obesity and optimization of preoperative fluid therapy. Obes Surg. 2013;23(11):1799-805. [Crossref] [PubMed]
- Milic DJ, Pejcic VD, Zivic SS, Jovanovic SZ, Stanojkovic ZA, Jankovic RJ, et al. Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2007;21(9):1588-92. [Crossref] [PubMed]
- Kopec AK, Abrahams SR, Thornton S, Palumbo JS, Mullins ES, Divanovic S, et al. Thrombin promotes diet-induced obesity through fibrin-driven inflammation. J Clin Invest. 2017;127(8):3152-66. [Crossref] [PubMed] [PMC]
- Vilahur G, Ben-Aicha S, Badimon L. New insights into the role of adipose tissue in thrombosis. Cardiovasc Res. 2017;113(9):1046-54. [Crossref] [PubMed]
- Chapin JC, Hajjar KA. Fibrinolysis and the control of blood coagulation. Blood Rev. 2015;29(1):17-24. [Crossref] [PubMed] [PMC]
- Kumagai G, Wada K, Kudo H, Asari T, Ichikawa N, Ishibashi Y. D-dimer monitoring combined with ultrasonography improves screening for asymptomatic venous thromboembolism in acute spinal cord injury. J Spinal Cord Med. 2020;43(3):353-7. [Crossref] [PubMed] [PMC]
- Amin B, Zhang C, Yan W, Sun Z, Zhang Y, Du D, et al. Effects of pneumoperitoneum of laparoscopic cholecystectomy on the coagulation system of patients: a prospective observational study. Chin Med J (Engl). 2014;127(14):2599-604. [PubMed]
- Donmez T, Uzman S, Yildirim D, Hut A, Avaroglu HI, Erdem DA, et al. Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy? PeerJ. 2016;4: e2375. [Crossref] [PubMed] [PMC]
- Garg PK, Teckchandani N, Hadke NS, Chander J, Nigam S, Puri SK. Alteration in coagulation profile and incidence of DVT in laparos copic cholecystectomy. Int J Surg. 2009; 7(2):130-5. [Crossref] [PubMed]
- Lauro A, Boselli C, Bufalari A, Fabbri B, Cirocchi R, Fabbri C, et al. Modificazioni perioperatorie dei tassi plasmatici di fibrinogeno e D-dimero in corso di colecistectomia laparoscopica: risultati preliminari di uno studio clinico prospettico randomizzato [Perioperative changes in the plasma levels of fibrinogen and D-dimer during laparoscopic cholecystectomy: the preliminary results of a prospective randomized clinical study]. Ann Ital Chir. 1999; 70(4):561-7. Italian. [PubMed]
- Martinez-Ramos C, Lopez-Pastor A, Nú-ez-Pe-a JR, Ruiz-Caravaca ML, Ruiz de Gopegui M, Sanz-López R, et al. Fibrinolytic activity in laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 1998;8(6):417-23. [Crossref] [PubMed]
- Masoomi H, Buchberg B, Reavis KM, Mills SD, Stamos M, Nguyen NT. Factors predictive of venous thromboembolism in bariatric surgery. Am Surg. 2011;77(10):1403-6. [Crossref] [PubMed]
- Winegar DA, Sherif B, Pate V, DeMaria EJ. Venous thromboembolism after bariatric surgery performed by bariatric surgery center of excellence participants: Analysis of the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2011;7(2):181-8. [Crossref] [PubMed]
- Liu C, Han Z, Zhang N, Peng J, Zhu B, Amin B, et al. Laparoscopic sleeve gastrectomy affects coagulation system of obese patients. Obes Surg. 2020;30(10):3989-96. [Crossref] [PubMed]
- Rottenstreich A, Elazary R, Yuval JB, Spectre G, Kleinstern G, Kalish Y. Assessment of the procoagulant potential after laparoscopic sleeve gastrectomy: a potential role for extended thromboprophylaxis. Surg Obes Relat Dis. 2018;14(1):1-7. [Crossref] [PubMed]
- Nguyen NT, Owings JT, Gosselin R, Pevec WC, Lee SJ, Goldman C, et al. Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass. Arch Surg. 2001;136(8):909-16. [Crossref] [PubMed]
- Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients-what have we learned? Obes Surg. 2000;10(6):509-13. [Crossref] [PubMed]
- Froehling DA, Daniels PR, Mauck KF, Collazo-Clavell ML, Ashrani AA, Sarr MG, et al. Incidence of venous thromboembolism after bariatric surgery: a population-based cohort study. Obes Surg. 2013;23(11):1874-9. [Crossref] [PubMed] [PMC]
- Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10(3):233-9. [Crossref] [PubMed]
- Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg. 2000;10(1):7-13; discussion 14. [Crossref] [PubMed]
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