Coagulation and deep vein flow changes following laparoscopic total extraperitoneal inguinal hernia repair: a single-center, prospective cohort study

Predictive value of D-dimer and fibrinogen degradation product for splanchnic vein thrombosis in patients with severe acute pancreatitis: a single-center retrospective study

BACKGROUND AND AIM

Early diagnosis of splanchnic vein thrombosis (SVT) after severe acute pancreatitis (SAP) remains difficult because of its insidious onset. Common serum markers for thrombosis such as D-dimer (D-D) have lost their diagnostic value due to their elevation in non-thrombotic patients with SAP. The aim of this study is to predict SVT after SAP using common serum indicators of thrombosis by establishing a new cut-off value.

METHODS

177 SAP patients were included in a retrospective cohort study from September 2019 to September 2021. Patient demographics, dynamic changes of coagulation and fibrinolysis indicators were collected. Univariate analyses and binary logistic regression analyses were applied to assess potential risk factors for the development of SVT in SAP patients. A receiver operating characteristic (ROC) curve was generated to assess the predictive value of independent risk factors. Moreover, clinical complications and outcomes were compared between two groups.

RESULTS

Among 177 SAP patients, 32 (18.1%) developed SVT. The most common cause of SAP was biliary (49.8%), followed by hypertriglyceridemia (21.5%). Multivariate logistic regression analyses showed that D-D (OR, 1.135; 95%CI, 1.043-1.236; p = 0.003) and fibrinogen degradation product (FDP) (OR, 1.037; 95%CI, 1.015-1.060; p = 0.001) were independent risk factors for SVT development in patients with SAP. The area under ROC curve for D-D was 0.891 (p = 0.003, sensitivity= 95.3%, specificity = 74.1%) at a cut-off value of 6.475, and the area under ROC curve for FDP was 0.858 (p = 0.001, sensitivity = 89.4%, specificity = 72.4%) at a cut-off value of 23.155.

CONCLUSION

D-D and FDP are significant independent risk factors with high predictive value for SVT in patients with SAP.

The significance of coagulation and fibrinolysis-related parameters in predicting postoperative venous thrombosis in patients with breast cancer

Background

To explore the expression level of coagulation and fibrinolysis-related indexes in the plasma of breast cancer patients after surgery, and explore their predictive value for deep venous thrombosis (DVT).

Methods

From May 2016 to May 2019, 63 patients with lower extremity DVT after radical mastectomy in our hospital were selected as the thrombus group, and 69 patients without venous thrombosis after radical mastectomy were selected as the control group. The levels of D-dimer (D-D) and fibrinolytic product (FDP) were measured by latex enhanced immunoturbidimetry, Fibrinogen (FIB) levels were measured using the von Clauss method, thrombin antithrombin complex (TAT) and thrombomodulin (TM) levels were measured by enzyme-linked immunosorbent assay (ELISA), and the evaluation value of coagulation markers on tumor thrombosis was analyzed by receiver operating characteristic curve (ROC) curve analysis.

Results

There were significant differences in blood pressure, platelet count (PLT) level, diabetes history, and tumor metastasis between the two groups (P<0.05). The levels of PT, D-D, FDP, TAT, and TM in the thrombus group were significantly higher than those in control group (P<0.05). The area under the curve (AUC) of D-D, FDP, and TAT were 0.790, 0.881, and 0.672, respectively and there was a marked difference among the indexes (P<0.05). The AUC of FDP was the largest, and the sensitivity and diagnostic value of FDP were the highest.

Conclusions

The plasma levels of FDP, D-D, TAT, and TM in breast cancer patients with DVT after radical mastectomy were significantly increased, which is related to imbalanced coagulation and fibrinolysis functioning in patients. FDP had the highest predictive value for DVT after radical mastectomy.

Complicated, Complete, Indirect, Irreducible Right Inguinoscrotal Hernia

Inguinal hernias are the most common of all hernias. A complicated hernia is irreducible, and the contents are obstructed or strangulated. Sonography is considered the imaging modality of choice for the diagnosis of abnormalities of the inguinal area. This case study is about a patient with an inguinal hernia that had not been repaired and progressed into a life-threatening, complicated inguinoscrotal hernia. The patient’s complaints and clinical findings required sonographic examinations of the abdomen, pelvis, inguinal canal, and scrotum. Sonographic findings were corroborated by findings with computed tomography (CT). After the compromised intestine was resected and the hernia was repaired, the patient developed a deep vein thrombosis (DVT), identified sonographically. The patient was successfully treated and discharged.

Laparoscopic Sleeve Gastrectomy Affects Coagulation System of Obese Patients

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is nowadays the most popular bariatric procedure for obesity. However, whether LSG increases the risk of thrombosis remains unclear. The aim of this study was to investigate potential effects of LSG on coagulation system.

METHODS

Fifty-five obese patients underwent LSG between 2016 and 2018. The LSG was performed with pneumoperitoneum pressure maintained at 13 mmHg. Venous blood specimens were collected from each patient before surgery, at the end of pneumoperitoneum (i.e., 0 h after surgery), and at 24 h after surgery to determine prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet count (PLT), D-dimer (D-D), red blood cell count (RBC), hematocrit (HCT), plateletcrit (PCT), cholesterol (CHOL), triglyceride (TRIG), and serum calcium (Ca). All patients were examined on the veins of the lower limbs by color Duplex sonography (CDS) before surgery and at 24 h after surgery, respectively.

RESULTS

All patients successfully underwent LSG. No severe surgery-related complications were observed during 1-month follow-up after operation. Preoperative BMI was 43.6 ± 8.3 kg/m². The levels of coagulation factors were within the normal range before surgery, except a relatively higher PLT. The PT and D-D were increased at 0 h and 24 h after surgery (P < 0.05), whereas APTT was decreased (P < 0.05). The postoperative FIB remained similar to the preoperative one (P > 0.05). The CDS identified no thrombus in the veins of the lower limbs, either before surgery or at 24 h after surgery.

CONCLUSIONS

LSG may cause postoperative hypercoagulability of patients with obesity.