Coagulation System Disorders and Thrombosis Prophylaxis During Laparoscopic Fundoplications

Area of Science:

• Vascular Surgery
• Thrombosis Research
• Anesthesiology

Background:

• Deep vein thrombosis (DVT) is a risk following laparoscopic fundoplication.
• Optimal DVT prophylaxis regimens require assessment based on coagulation status and DVT rates.
• Comparing different low-molecular-weight heparin (LMWH) administration timings is crucial for patient safety.

Purpose of the Study:

• To determine the optimal timing for LMWH administration for DVT prophylaxis during and after laparoscopic fundoplication.
• To evaluate the impact of LMWH timing on coagulation disorders and DVT incidence.
• To recommend the most effective DVT prophylaxis strategy.

Main Methods:

• A prospective randomized clinical study involving 121 patients undergoing laparoscopic fundoplication.
• Two groups received LMWH: 12 hours pre-op (Group I) or 1 hour pre-op (Group II).
• Both groups used intermittent pneumatic compression; DVT assessed via Doppler ultrasound and CT venography; coagulation markers (F1+2, TAT, MP-TF, fTFPI) were measured.

Main Results:

• LMWH 1 hour pre-op significantly reduced hypercoagulation markers (F1+2, TAT, MP-TF) and increased anti-coagulation markers (fTFPI) compared to 12 hours pre-op.
• DVT occurred in 3.6% of patients receiving LMWH 12 hours pre-op, with no DVT in the group receiving LMWH 1 hour pre-op.
• Overall DVT rate was 1.65%.

Conclusions:

• Administering LMWH 1 hour before laparoscopic fundoplication, along with intraoperative pneumatic compression, is more effective in controlling hypercoagulation.
• This optimized regimen significantly reduces procoagulant markers and increases anticoagulant markers.
• The 1-hour pre-op LMWH strategy is recommended for DVT prophylaxis in this surgical context.