Журнал клинических случаев

Risk of Thromboembolic Complications in Morbidly Obese Patients Treated with Laparoscopic Bariatric Surgery

Abstract

Iwan-Ziętek I, Dąbrowiecki S, Rość D, Zietek-Czeszak A and Zietek Z

Purpose: The obesity is a metabolic disturbance which is associated with blood hypercoagulability. The purpose of the study was to evaluate if the bariatric procedure increases the risk of thromboembolic complications in morbidly obese patients. Methods: The study involved 38 patients with BMI over 35 who underwent laparoscopic gastric banding. The reference group consisted of 30 surgical patients. The following parameters were examined: Tissue Factor (TF) antigen (TF: Ag) and activity (TF: Ac), its inhibitor - Tissue Factor Pathway Inhibitor (TFPI) antigen (TFPI: Ag) and activity (TFPI: Ac), concentration of thrombin/antithrombin complexes (TAT) and activity of antithrombin (AT). Results: Bariatrics patients had significantly higher levels of TF: Ag (151,9)(p<0.04) and TF: Ac (1,42)(p<0.05) in comparison with reference group (91,3 and 0.1 respectively). Similar was with TFPI, where its TFPI: Ag (85,3) TFPI: Ac (1.16) were higher compared to reference group (67.3 and 1.1 respectively) however the differences did not reach statistically significant level. The level of TAT complexes was also significantly higher in morbidly obese patients (16,7 vs 8.3) (p<0.031) but the activity of AT III was similar in both groups. Based on above in morbidly obese patients a hypercoagulable state can be recognized which was caused by TF. After procedure TF:Ag was almost in the same level as before with the same tendency to reference group (p<0.05) however IF:Ac was insignificant lower (p<0.48). Similar tendency was observed with other parameters which was an evidence for persistent hypercoagulable state despite of a postoperative decrease of TF activity (p<0.27). This means that the bariatric procedure did not influence on blood coagulation of morbidly obese patients. In multivariate regression analysis was shown that only BMI, history of deep vein thrombosis or history of pulmonary complications are an independent factor of postoperative complications connecting with haemostasis. Conclusions: Laparoscopic bariatric procedures are not at increased risk of thromboembolic complications in morbidly obese patients.