Thrombocytosis after prophylactic administration of enoxaparin: unexpected findings in a Polish prospective multicenter trial on the efficacy and safety of enoxaparin in the prevention of postoperative thromboembolism

BACKGROUND

Heparin-related thrombocytopenia is a common complication of heparin administration and therefore platelet count was monitored in our study.

METHODS

EXPERIMENTAL DESIGN

Prospective multicentre study.

SETTING

14 Departments of General, Thoracic or OrthopaedicSurgery, Poland.

PATIENTS

290 patients--150 general or thoracic surgery patients aged above 40 years, and 140 orthopaedic surgery patients aged between 18 and 60 years.

INTERVENTIONS

All patients received 20 mg (general and thoracic surgery) or 40 mg of enoxaparin (orthopaedic surgery) once daily subcutaneously both before surgery and during postoperative immobilisation.

MEASURES

Platelet count was evaluated prior to surgery and on the 5th, 7th, 11th and 15th day following the operation.

RESULTS

There was neither thrombocytopenia nor heparin-induced thrombosis. Paradoxically, postoperative platelet count in most cases increased slightly but statistically significantly, but in some however, even above 600 G/l, nevertheless in these patients no thrombotic complications occurred. Postoperative thrombocytosis was greater in patients with neoplasms as well as those with excessive perioperative blood loss and transfusions.

CONCLUSIONS

As platelet count was not the main topic of our study, the presented data should be regarded only as preliminary. Further investigations to resolve the cause of the observed phenomenon of thrombocytosis are therefore necessary.

[Second look in abdominal surgery]

The paper presents authors experience and indications for an elective relaparotomy performed as the second-look laparotomy after primary operation. 12 patients with vascular or surgical diseases were operated on for: abdominal neoplastic tumors (2 patients), elective abdominal aneurysm (2 patients), ruptured abdominal aneurysm (2), abdominal aneurysm ruptured into the inferior caval vein (1), ruptured aneurysm of the iliac artery (1), abdominal aortic coarctation with visceral arteries abnormality (1), thrombosis of the superior mesenteric artery (1) and peritonitis because of intestinal ischaemia and necrosis (2 patients). In all cases an elective relaparotomy was done on the 1st or 2nd postoperative day. 5 patients died, in 4 cases complications found during second look relaparotomy required surgical treatment (2 of this patients died, two other were successfully treated). The authors discuss indications and advantages of elective second-look laparotomy in abdominal surgery according to the anticipated risk factors and patients condition.