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Postoperative Anticoagulation Therapy Necessary in Patients Following Major Surgery: Presented at ASA

By Lexa W. Lee

NEW ORLEANS -- October 18, 2009 -- Timely postoperative anticoagulation therapy is a surgical necessity, according to results of a new study presented at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA). Most procoagulant factors increase significantly within the first 6 days after major surgery, the study determined.

Postoperative hypercoagulability is thought to be due to a reactive upregulation of the clotting system, although its time response has not been well investigated, explained lead investigator Susanne Lison MD, anaesthesiologist, University Hospital of Munich, Munich, Germany, speaking here on October 17. The goal of this study was to describe postoperative clotting changes in patients who have had major surgery, she noted.

There were 33 patients in the study (20 male). The mean age was 65 years. The researchers included patients undergoing elective major surgery associated with a risk of bleeding, such as abdominal, oral, and gynaecological tumour surgery, as well as vascular operations.

Blood samples were taken before surgery and every morning for 6 days postoperatively.

Prothrombin time, activated partial prothrombin time (aPTT), and their associated clotting factors (fibrinogen and von Willebrand factor antigen [VWF AG]) were analysed.

The mean preoperative VWF AG value was 176% +- 65%. On postoperative day 1, there was a marked increase to 240% +- 82%; on postoperative day 3, it reached a peak of 308% +- 82% (all values P < .05).

The mean preoperative plasma level of fibrinogen was 354 mg/dL +- 91 mg/dL. On postoperative day 2, there was a significant increase to 484 mg/dL +- 79 mg/dL; on postoperative day 3, it reached a peak of 504 mg/dL +- 69 mg/dL (all values P < .05).

The mean preoperative level of Factor VIII was 119% +- 38%. On postoperative day 2, there was a significant increase to 148% +- 40%; on postoperative day 6, it reached a peak of 163% +- 29% (all values P < .05).

The mean preoperative level of Factor IX was 112% +- 25%. On postoperative day 3, there was a significant increase to 140% +- 24%; on postoperative day 6, it reached a peak of 155% +- 23% (all values P < .05).

Factors II, VII, and X decreased significantly by approximately 20% on postoperative days 1 and 2, while there was an insignificant decrease of about 10% in PT. There were no significant changes in aPTT.

The researchers concluded that there is a need for early postoperative anticoagulation measures in these patients based on the significant increase in most clotting factors in the first 6 days following major surgery, starting as early as postoperative day 2.

[Presentation title: Postoperative Hemostasis in Patients Undergoing Major Surgery. Abstract A60]

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