August 23rd, 2019

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Laparotomy Affects D-Dimer and Antithrombin-III Levels in Women Undergoing Surgery for Gynecologic Indications
Authors:  Kelly J. Manahan, M.D., M.B.A., Patricia A. Fisher, B.S.N., and John P. Geisler, M.D., M.S.Pharm.
  OBJECTIVE: Vascular thromboembolic events (VTEs) are a frequent cause of morbidity and even mortality after gynecologic surgery. The purpose of this pilot study was to determine whether there were changes in d-dimer and antithrombin III (ATIII) levels from the preoperative period to the first 24–28 hour postoperative period.

STUDY DESIGN: Consecutive series of 40 patients undergoing laparotomy for gynecologic indications (20 malignancies and 20 benign). Blood was taken preoperatively and within 24 hours postoperatively.

RESULTS: ATIII levels were normal in all patients preoperatively. Although all ATIII levels remained within normal limits after surgery, there was a significant decrease in ATIII levels (p<0.001). One of 20 patients with gynecologic malignancies had elevated d-dimers preoperatively. All patients had postoperative d-dimers that were elevated (p<0.001).

CONCLUSION: Changes in d-dimer and ATIII levels occur in the majority of patients in the first 24–28 hours postoperatively in patients undergoing laparotomy for gynecologic indications (cancer or benign). Elevated d-dimer levels postoperatively preclude its use in an algorithm for working up VTE up to 48 hours after surgery. Laparotomy adversely affects d-dimer and ATIII levels in women undergoing laparotomy for gynecologic indications.
Keywords:  antithrombin III, d-dimer, gynecologic surgery, laparotomy
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