PERIOPERATIVE PREVENTION OF THROMBOSIS IN PATIENTS WITH HEMOSTASIS DISORDERS

Abstract

The  aim  of  the   study   is  to  individualize  prevention of  thrombosis in  abdominal surgery,  using  assessment of  hemostasis functional state. The key  sign  of  hemostasis functional state is the  character of  the  blood  clot  depends on  thromboelastography or electrocoagulography. Medication for prevention of thrombosis may be started over 6 to 8 hours  after the end of surgery  in hemorrhagic variant  of hemostasis subcompensation. In this case anticoagulant of choice is unfractionated heparin given in continuous infusion 100-500  units/hour (1-5 units/kg/hour). As blood  clot is stabilized, anticoagulation changeover to low molecular weight heparin, the drug of choice is the dalteparin. In those  patients who receive prolonged antithrombotic therapy, length  of preoperative bridge therapy may vary, according the structural features of formed clot (based on the electrocoagulography data obtained directly prior to routine anticoagulant injection). In the presence of dense clot (i.e., in thrombotic variant of haemostasis subcompensation) last injection of low molecular weight  heparin  may be done in 12 hours before surgery without risk of bleeding.