Perioperative Changes in Plasma Antithrombin Activity and Platelet Counts in Patients Undergoing Gynecologic Surgery

Takashi Watanabe; Akihide Ohkuchi; Hisanori Minakami; Yoichi Sakata; Shigeki Matsubara; Tomoaki Wada; Tamaho Onagawa; Ikuo Sato

doi:10.1055/s-2002-36694

Seminars in Thrombosis and Hemostasis, Inhaltsverzeichnis

Semin Thromb Hemost 2002; 28(6): 519-524
DOI: 10.1055/s-2002-36694

Perioperative Changes in Plasma Antithrombin Activity and Platelet Counts in Patients Undergoing Gynecologic Surgery

Takashi Watanabe¹ , Akihide Ohkuchi² , Hisanori Minakami³ , Yoichi Sakata⁴ , Shigeki Matsubara¹ , Tomoaki Wada¹ , Tamaho Onagawa¹ , Ikuo Sato¹

¹Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi
²Department of Obstetrics and Gynecology, Kamitsuga General Hospital, Tochigi
³Department of Reproductive and Developmental Medicine, Hokkaido University Graduate School of Medicine, Sapporo
⁴Division of Thrombosis and Hemostasis, Institute of Hematology, Jichi Medical School, Tochigi, Japan

Abstract

ABSTRACT

The relationships among perioperative changes in plasma antithrombin (AT) activity, platelet counts, and clinical risk factors for postoperative thromboembolism has not been studied extensively in gynecologic patients. AT activity and platelet counts were determined preoperatively and on postoperative days 1 and 7 in 74 patients who underwent gynecologic surgery. The relationships between each clinical risk factor for postoperative thromboembolism and the decrease in AT activity and platelet count were analyzed using a univariate logistic regression model. No clinically significant thromboembolism occurred in any patient. AT activity and platelet counts decreased significantly on postoperative day 1 and exceeded preoperative levels on day 7. Postoperative patients with malignancy were more likely to exhibit decreased AT activity. AT activity decreased significantly with increases in operating time and blood loss. Known risk factors for postoperative thromboembolism did not appear to be associated with postoperative decreases in platelet counts. Transient hyperconsumption of AT and platelets occurs immediately after gynecologic surgery. Surgery-induced AT deficiency may contribute to postoperative thromboembolism in patients with long operating times and significant blood loss.

KEYWORD

Antithrombin activity - gynecologic surgery - platelet count - thromboembolism - risk factor

Volltext

Referenzen

REFERENCES

1 Urlep-Salinovic V, Jelatancev B, Gorisek B. Low dose of heparin and heparin dihydergot in postoperative thromboprophylaxis in gynaecological patients. Thromb Haemost . 1994; 72 16-20
2 Clarke-Pearson D L, Hume R F. Venous thromboembolic disease in obstetrics and gynecology: prevention, diagnosis, and treatment. Curr Probl Obstet Gynecol Fertil . 1989; 12 42-63
3 Merli G J, Martinez J. Prophylaxis for deep vein thrombosis and pulmonary embolism in the surgical patient. Med Clin North Am . 1987; 71 377-397
4 Lane D A, Olds R F, Thein S L. Antithrombin and its deficiency. In: Bloom AL, Forbes CD, Thomas DP, Tuddenham EGD, eds. Haemostasis and Thrombosis London, UK: Longham Singapore Publishers 1994: 655-670
5 Sugimoto H, Sasaki S, Aoi K. Antithrombin deficiency after major surgery. ICU & CCU . 1995; 19 879-888
6 Shinohara M, Kurokawa H, Yoshihara Y. Responses to surgical stress in blood coagulation and fibrinolysis, platelet counts and thromboxane B₂ after esophageal cancer operation. Rinsho Byori . 1997; 45 179-184
7 Sacher R A, McPherson R A. Hemostasis and tests of hemostatic function. In: Sacher RA, McPherson RA, eds. Widermann's Clinical Interpretation of Laboratory Tests Philadelphia, PA: FA Davis 2000: 237-261
8 Harker L A, Slichter S J. Platelet and fibrinogen consumption in man. N Engl J Med . 1972; 287 999-1005
9 Bellucci S, Janvier M, Tobelem G. Essential thrombocythemias. Clinical evolutionary and biological data. Cancer . 1986; 58 2440-2447
10 Scully M F, Kakkar V V. Methods for semi micro or automated determination of thrombin, antithrombin, and heparin cofactor using the substrate, H-D-Phe-Arg-p-nitroanilide 2HCl. Clin Chim Acta . 1977; 79 595-602
11 Turner-Gomes S O, Nitschmann E P, Norman G R, Andrew M E, Williams W G. Effect of heparin loading during congenital heart operation on thrombin generation and blood loss. Ann Thorac Surg . 1997; 63 482-488
12 Goldhaber S Z, Grodstein F, Stampfer M J. A prospective study of risk factors for pulmonary embolism in women. JAMA . 1997; 277 642-645