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