Risk factors for thromboembolic complications in patients with elevated body mass index during the perioperative period of laparoscopic myomectomy

Authors

  • T.O. Maksymets Odessa National Medical University, Odesa, Ukraine; Medical Center “Mother and Child” at the Neomed 2007 LLC, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.5.2021.240714

Keywords:

uterine fibroid, body mass index, risk factors, laparo­scopy, risk of thrombosis, thromboprophylaxis

Abstract

Background. Uterine fibroid is one of the most common diseases in gynaecological practice accounting from 32 to 70 % according to various authors. In 80 % of cases, fibroids are observed in women of reproductive age. Laparoscopic myomectomy is one of the main methods of surgical treatment for uterine fibroids in wo­men of reproductive age. A large number of advantages of this method of surgical treatment in many cases lead to underestimation of the existing risks such as the risk of thrombosis in women with elevated body mass index (BMI). The purpose of this study is to detect the risk of thrombosis in adequate comprehensive thromboprophylaxis of patients with elevated BMI in the perioperative period of laparoscopic myomectomy using an instrumental method of diagnosis such as low-frequency piezoelectric blood viscometer. Materials and methods. Patients aged 30–45 years undergoing laparoscopic myomectomy (n = 60) were exa­mined. They were divided into 3 groups depending on the BMI and thromboprophylaxis method. Group 1 (n = 16) included women with the BMI < 30 kg/m2, who did not receive thromboprophylaxis. Group 2 (n = 18) consisted of patients with the BMI > 30 kg/m2, who were treated with enoxaparin thromboprophylaxis at a dose of 2,000 anti-Xa IU/0.2 ml subcutaneously (at the BMI of 30–40 kg/m2) and 4,000 anti-Xa IU/0.4 ml subcutaneously (at the BMI > 40 kg/m2). Third group (n = 26) included individuals with the BMI > 30 kg/m2 who received enoxaparin and pentoxifylline for thromboprophylaxis. Results. The low-frequency piezoelectric blood viscometry revealed statistically significant (p < 0.05) deviations from the reference values of the coagulogram towards structural (increased maximum clot density) and chronometric hypercoagulation (acceleration of the time of formation of fibrin-platelet structure T5, shift of the blood clotting time T3 to the left, an increase in the intensity of coagulation drive), elevated thrombin activity (an increase in the constant of thrombin activity, a decrease in T2 time), activation of vascular-platelet hemostasis (reduced period of T1 reaction onset, increased intensity of contact coagulation), inhibition of the lytic activity (a decrease in the intensity of retraction and lysis of the clot) in groups 2 and 3. On the first day after surgery in groups 2 and 3, there was a significant increase (compared to preoperative indicators) in the chronometric indicators such as T1, T2 and T5; a decrease in the structural indicator of maximum clot density, as well as a significant decrease in the constant of thrombin activity, intensity of contact coagulation, which confirms the effectiveness of antithrombotic therapy. However, group 2 reported an increase in the activity of vascular-platelet hemostasis, higher intensity of contact coagulation compared to group 3, shorter T1 and T2 time, and the constant of thrombin activity was higher. On the 5th day after surgery, a normocoagulation trend of hemostatic potential was observed in all groups of patients. Conclusions. The use of low-frequency piezoelectric blood viscometry allows reliably and quickly assessing the kinetics of thrombosis formation.

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References

Адамян Л.В., Зарубиани З.Р., Киселев С.И. Лапароскопия и гистерорезектоскопия в хирургическом лечении миомы матки у женщин детородного возраста. Акушерство и гинекология. 2014. № 3. С. 40-44.

Parker W.H. Etiology, symptomatology, and diagnosis of ute­rine myomas. Fertil. Steril. 2015. Vol. 87. Р. 725-736.

Cullen D.J., Coyle J.P., Teplick R., Long M.C. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdomi­nal pressure in critically ill patients. Crit. Care Med. 1989. Vol. 17(2). Р. 118-121. doi: 10.1097/00003246-198902000-00002.

Jamal M.H., Corcelles R., Shimizu H. et al. Thromboembolic events in bariatric surgery: a large multiinstitutional referral center experience. Surg. Endosc. 2015. Vol. 29. Р. 376-380.

Bartlett M.A., Mauck K.F., Daniels P.R. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc. Health Risk. Manag. 2015. Vol. 11. Р. 461-477. doi: 10.2147/VHRM.S73799.

Козаченко А.В. Особенности эстрогенного статуса и содержания рецепторов эстрогенов и прогестерона у больных миомой матки. Тез. докл. форума «Пути развития современной гинекологии». 2015.

Спиридонова Н.В., Басина Е.И. Клинико-прогностические аспекты содержания аутоантител к TRM-03 у пациенток с миомой матки репродуктивного возраста. Практическая медицина. 2016. № 1(93). С. 85-90.

Винокурова Е.А. Влияние оперативного лечения на гемокоагуляцию у больных раком и миомой тела матки. Российский вестник акушера-гинеколога. 2008. Т. 8. № 1. С. 8-12.

Robertson D., Lefebvere G., Leyland N. et al. Adhesion prevention in gynaecological surgery. Journal of obstetrics and gynaeco­logy Canada. 2010. Vol. 32. № 6. Р. 598-608.

Давыдов А.И., Чочаева Е.М., Пашков В.М., Лебедев В.А. и др. Предоперационная подготовка больных миомой матки: целесообразность и эффективность. Вопросы гинекологии, акушерства и перинатологии. 2015. № 14(6). С. 54-60.

Буриков М.А., Сказкин И.В., Шульгин О.В., Кинякин А.И., Сокиренко И.А., Волкова Н.В. Особенности профилактики интраоперационных тромбоэмболических осложнений у пациентов с морбидным ожирением. Клиническая практика. 2018. Т. 9. № 3. С. 44-47.

Тарабрін О.О., Сажин Д.С., Сухонос Р.Є., Володичев Д.С., Потапчук Ю.О., Суслов О.С., Тарабрін П.О. Порівняння інструментальних методів дослідження гемостазу. Клінічна анестезіологія та інтенсивна терапія. 2018. № 1. С. 23-28.

Тарабрин О.А. Нарушения системы гемостаза у онкологических больных. Онкогинекология. 2015. № 3. С. 48-56.

Удут В.В., Тютрін І.І., Тарабрін О.О., Тарабрін П.О. Низькочастотна п’єзотромбоеластографія цільної крові (алгоритми діагностики та корекції гемостазіологічних розладів). 2018. С. 9-58.

Хоробрых О.С. Проблемы оказания анестезиологических пособий у пациенток с ожирением в акушерстве. Здравоохранение Югры: опыт и инновации. 2018. № 4. С. 41-45.

Клигуненко О.М., Кріштафор Д.А. Тромбопрофилактика при ожирении: обзор современных рекомендаций. Український медичний часопис. 2019. № 3(2). С. 8-11. DOI: 10.32471/umj.1680-3051.131.157638.

Published

2022-01-10

How to Cite

Maksymets, T. (2022). Risk factors for thromboembolic complications in patients with elevated body mass index during the perioperative period of laparoscopic myomectomy. EMERGENCY MEDICINE, 17(5), 89–95. https://doi.org/10.22141/2224-0586.17.5.2021.240714

Issue

Section

Original Researches