Luca Spiezia1, Marco Cuzzolin2, Hernandez Elssy3, Guido Di Gregorio3, Elena Campello1, Federico Rea2, Andrea Zuin2, Paolo Simioni1. 1. Haemorrhagic and Thrombotic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy. 2. Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy. 3. Cardiothoracic Anaesthesia Unit, Department of Medicine, Padua University Hospital, Padua, Italy.
Abstract
BACKGROUND: Patients undergoing video-assisted thoracoscopic surgery (VATS) have a lower risk of thrombosis compared to those undergoing open thoracotomy (OT) which may be due to several post-operative factors such as early mobilisation, shorter hospital stays, lower transfusion rates and lower risk of infections. Whether the higher thrombotic risk after OT is also linked to a peri-operative hypercoagulable state is a matter of debate. We therefore conducted a case-control study to compare peri-operative coagulation profiles in patients with primary lung cancer undergoing VATS vs OT. MATERIALS AND METHODS: All consecutive patients undergoing VATS or OT for primary lung cancer at the Department of Thoracic Surgery of Padua University Hospital, Italy, between February and June 2018 were enrolled. Each patient provided a venous blood sample at least 30 min prior to surgical incision (T0) and 4±1 days after surgery (T1). Peri-operative coagulation profiles were assessed via traditional, viscoelastic whole blood (ROTEM® [Instrumentation Laboratory-Werfen]) and impedance aggregometry (Multiplate® Analyser [Roche Diagnostics]) tests. RESULTS: We enrolled 65 patients (males 43, females 22; mean age 65±13 years) of whom 35 (54%) underwent VATS and 30 (46%) underwent OT. Compared to healthy controls, the surgical group (VATS and OT patients) had a significantly shorter clot formation time and higher alpha angle and maximum clot firmness values, as well as increased mean platelet function. In the post-operative period, patients who underwent OT had a significantly shorter clot formation time, higher alpha angle and maximum clot firmness values and higher mean platelet function vs VATS patients. DISCUSSION: Whole blood ROTEM® profiles and Multiplate® aggregometry identified a more hypercoagulable post-operative state in patients who underwent OT than in those who underwent VATS. Larger studies are warranted to confirm our results and ascertain whether the observed hypercoagulability might promote post-operative thrombosis.
BACKGROUND:Patients undergoing video-assisted thoracoscopic surgery (VATS) have a lower risk of thrombosis compared to those undergoing open thoracotomy (OT) which may be due to several post-operative factors such as early mobilisation, shorter hospital stays, lower transfusion rates and lower risk of infections. Whether the higher thrombotic risk after OT is also linked to a peri-operative hypercoagulable state is a matter of debate. We therefore conducted a case-control study to compare peri-operative coagulation profiles in patients with primary lung cancer undergoing VATS vs OT. MATERIALS AND METHODS: All consecutive patients undergoing VATS or OT for primary lung cancer at the Department of Thoracic Surgery of Padua University Hospital, Italy, between February and June 2018 were enrolled. Each patient provided a venous blood sample at least 30 min prior to surgical incision (T0) and 4±1 days after surgery (T1). Peri-operative coagulation profiles were assessed via traditional, viscoelastic whole blood (ROTEM® [Instrumentation Laboratory-Werfen]) and impedance aggregometry (Multiplate® Analyser [Roche Diagnostics]) tests. RESULTS: We enrolled 65 patients (males 43, females 22; mean age 65±13 years) of whom 35 (54%) underwent VATS and 30 (46%) underwent OT. Compared to healthy controls, the surgical group (VATS and OT patients) had a significantly shorter clot formation time and higher alpha angle and maximum clot firmness values, as well as increased mean platelet function. In the post-operative period, patients who underwent OT had a significantly shorter clot formation time, higher alpha angle and maximum clot firmness values and higher mean platelet function vs VATS patients. DISCUSSION: Whole blood ROTEM® profiles and Multiplate® aggregometry identified a more hypercoagulable post-operative state in patients who underwent OT than in those who underwent VATS. Larger studies are warranted to confirm our results and ascertain whether the observed hypercoagulability might promote post-operative thrombosis.
Authors: Michelle B Mulder; Kenneth G Proctor; Evan J Valle; Alan S Livingstone; Dao M Nguyen; Robert M Van Haren Journal: World J Surg Date: 2019-12 Impact factor: 3.352
Authors: S Ziomek; R C Read; H G Tobler; J E Harrell; J C Gocio; L M Fink; T J Ranval; E J Ferris; D L Harshfield; D R McFarland Journal: Ann Thorac Surg Date: 1993-08 Impact factor: 4.330
Authors: N A Davies; N K Harrison; A Sabra; M J Lawrence; S Noble; S J Davidson; V J Evans; R H K Morris; K Hawkins; P R Williams; P A Evans Journal: Thromb Res Date: 2015-03-19 Impact factor: 3.944
Authors: Timothy J P Batchelor; Neil J Rasburn; Etienne Abdelnour-Berchtold; Alessandro Brunelli; Robert J Cerfolio; Michel Gonzalez; Olle Ljungqvist; René H Petersen; Wanda M Popescu; Peter D Slinger; Babu Naidu Journal: Eur J Cardiothorac Surg Date: 2019-01-01 Impact factor: 4.534
Authors: Federico Capone; Alberto Cipriani; Leonardo Molinari; Anna Poretto; Nicolò Sella; Annalisa Boscolo; Elena Campello; Alois Saller; Roberto Vettor; Paolo Navalesi; Anna Maria Cattelan; Paolo Simioni; Luca Spiezia Journal: Adv Med Sci Date: 2021-12-11 Impact factor: 3.287