Dynamic control of hemostasis during organ-sparing surgery in gynecologic practice
Siutkina I.P., Demura А.Yu., Rakitin F.A., Kochetkova M.V., Khabarov D.V.
Objective: This study aimed to examine changes in the hemostatic system and determine the presence or absence of a tendency for thrombus formation with the prophylactic use of tranexamic acid during conservative laparoscopic myomectomy.
Materials and methods: This study included 33 patients with multiple uterine fibroids, anemic syndrome, and a low risk of venous thromboembolism (VTE) who underwent surgery, including laparoscopic myomectomy. Two days before surgery, all patients received iron carboxymaltose infusion, and intraoperatively, they received tranexamic acid at a dose of 20 mg/kg. We conducted dynamic monitoring of coagulation and thromboelastography parameters, as well as ultrasound screening of veins in the lower extremities on the 6th day after surgery.
Results: The use of tranexamic acid resulted in hypercoagulable changes within the first 24 h after surgery, but these changes remained within the compensatory-adaptive limits. On the 6th day after surgery, patients still showed a tendency towards hypercoagulation, with elevated levels of fibrinogen, D-dimer, and SFMCs exceeding the reference values. This tendency was associated with the extent of surgery and initial anemia, indicating an ongoing risk of VTE, including hidden thrombosis.
Conclusion: The identified tendency towards hypercoagulation in patients with multiple uterine fibroids after laparoscopic conservative myomectomy necessitates constant monitoring of the hemostatic system and the development of effective measures to prevent VTE, including the use of low-molecular-weight heparins.
Authors' contributions: Siutkina I.P., Khabarov D.V. – conception and design of the study; Siutkina I.P., Rakitin F.A.,
Demura A.Yu. – material collection and processing; Siutkina I.P., Kochetkova M.V. – statistical analysis; Siutkina I.P. – drafting of the manuscript; Khabarov D.V. – editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest regarding the publication of this article.
Funding: Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Siutkina I.P., Demura А.Yu., Rakitin F.A., Kochetkova M.V., Khabarov D.V.
Dynamic control of hemostasis during organ-sparing surgery in gynecologic practice.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (4): 87-92 (in Russian)
https://dx.doi.org/10.18565/aig.2023.208
Keywords
conservative laparoscopic myomectomy
thromboelastography
thromboembolic complications
References
- Giuliani E., As-Sanie S., Marsh E.E. Epidemiology and management of uterine fibroids. Int. J. Gynaecol. Obstet. 2020; 149(1): 3-9. https://dx.doi.org/10.1002/ijgo.13102.
- Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., Манухин И.Б., ред. Гинекология. Национальное руководство. М.: ГЭОТАР-Медиа; 2022. 1008с. [Savel’eva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E., Manukhin I.B., eds. Gynecology. National Guide. Moscow: GEOTAR-Media; 2022. 1008p. (in Russian)].
- Tanos V., Berry K.E., Frist M., Campo R., De Wilde R.L. Prevention and management of complications in laparoscopic myomectomy. BioMed. Res. Int. 2018; 2018: 8250952. https://dx.doi.org/10.1155/2018/8250952.
- Ordás P., Spagnolo E., Fernández L.G., Diestro Tejeda M.D., Lafuente P., Salas P. et al. Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: a single-center cohort study. Front. Surg. 2022; 9: 997078. https://dx.doi.org/10.3389/fsurg.2022.997078.
- Chen R., Su Z., Yang L., Xin L., Yuan X., Wang Y. The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis. BMC Surg. 2020; 20(1): 55. https://dx.doi.org/10.1186/s12893-020-00703-0.
- Buckley V.A., Nesbitt-Hawes E.M., Atkinson P., Won H.R., Deans R., Burton A. et al. Laparoscopic myomectomy: clinical outcomes and comparative evidence. J. Minim. Invasive Gynecol. 2015; 22(1): 11-25. https://dx.doi.org/10.1016/j.jmig.2014.08.007.
- Catanese A., Siesto G., Cucinella G., Chiantera V., Culmone S., Schiattarella A. et al. Factors influencing surgical outcomes of laparoscopic myomectomy. A propensity-score matched analysis. Prz. Menopauzalny. 2022; 21(3): 149-56. https://dx.doi.org/10.5114/pm.2022.118970.
- Ye M., Zhou J., Chen J., Yan L., Zhu X. Analysis of hidden blood loss and its influential factors in myomectomy. J. Int. Med. Res. 2020; 48(5): 300060520920417. https://dx.doi.org/10.1177/0300060520920417.
- Тихомиров А.Л., Сарсания С.И. Лейомиома матки и ЖДА. Вариант предоперационной подготовки. Медицинский совет. 2019; 13: 178-82. [Tikhomirov A.L., Sarsaniya S.I. Uterine leiomyoma and IDA. Variant of preoperative preparation. Medical Council. 2019; (13): 178-82. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2019-13-178-182.
- Barbosa P.A., Villaescusa M., Andres M.P., Fernandes L.F.C., Abrão M.S. How to minimize bleeding in laparoscopic myomectomy. Curr. Opin. Obstet. Gynecol. 2021; 33(4): 255-61. https://dx.doi.org/10.1097/GCO.0000000000000725.
- Jorgensen E.M., Li A., Modest A.M., Leung K., Moore Simas T.A., Hur H.C. Incidence of venous thromboembolism after different modes of gynecologic surgery. Obstet. Gynecol. 2018; 132(5): 1275-84. https://dx.doi.org/10.1097/AOG.0000000000002918.
- Jorgensen E.M., Hur H.C. Venous thromboembolism in minimally invasive gynecologic surgery: a systematic review. J. Minim. Invasive Gynecol. 2019; 26(2): 186-96. https://dx.doi.org/10.1016/j.jmig.2018.08.025.
- Сяо Я. Инцидентность венозных тромбозов в европейской популяции: роль хирургических вмешательств. Медицина неотложных состояний. 2017; 4: 24-9. [Siao Y. The incidence of venous thrombosis in the European population: the role of surgical interventions. Emergency Medicine. 2017; (4): 24-9. (in Russian)]. https://dx.doi.org/10.22141/2224-0586.4.83.2017.107421.
- Nicholson M., Chan N., Bhagirath V., Ginsberg J. Prevention of venous thromboembolism in 2020 and beyond. J. Clin. Med. 2020; 9(8): 2467. https://dx.doi.org/10.3390/jcm9082467.
- Kathopoulis N., Prodromidou A., Zacharakis D., Chatzipapas I., Diakosavvas M., Kypriotis К. et al. The effect of intravenous tranexamic acid on myomectomy: a systematic review and meta-analysis of randomized controlled trials. J. Pers. Med. 2022; 12(9): 1492. https://dx.doi.org/10.3390/jpm12091492.
- Сюткина И.П., Хабаров Д.В., Ракитин Ф.А., Кочеткова М.В., Инешина А.Д. Комплексная оценка изменений свертывающей системы крови в периоперационном периоде при эмболизации маточных артерий. Акушерство и гинекология. 2019; 12: 133-9. [Syutkina I.P., Khabarov D.V., Rakitin F.A., Kochetkova M.V., Ineshina A.D. Integrated assessment of perioperative changes in the blood coagulating system during uterine artery embolization. Obstetrics and Gynecology. 2019; (12): 133-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.12.133-139.
- Waskowski J., Schefold J.C, Stueber F. Prophylaktische Anwendung von Tranexamsäure in der nichtkardialen Chirurgie: update 2017. [Prophylactic use of tranexamic acid in noncardiac surgery: update 2017]. Med. Klin. Intensivmed. Notfmed. 2019; 114(7): 642-9. (in German). https://dx.doi.org/10.1007/s00063-018-0402-5.
- Opoku-Anane J., Vargas M.V., Marfori C.Q., Moawad G., Maasen M.S., Robinson J.K. Intraoperative tranexamic acid to decrease blood loss during myomectomy: a randomized, double-blind, placebo-controlled trial. Am. J. Obstet. Gynecol. 2020; 223(3): 413.e1-413.e7. https://dx.doi.org/10.1016/j.ajog.2020.02.019.
- Hunt B.J. The current place of tranexamic acid in the management of bleeding. Anaesthesia. 2015; 70(Suppl. 1): 50-3, e18. https://dx.doi.org/10.1111/anae.12910.
- Shaaban M.M., Ahmed M.R., Farhan R.E., Dardeer H.H. Efficacy of tranexamic acid on myomectomy-associated blood loss in patients with multiple myomas: a randomized controlled clinical trial. Reprod. Sci. 2016; 23(7): 908-12. https://dx.doi.org/10.1177/1933719115623646.
- Wang D., Wang L., Wang Y, Lin X. The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017; 96(23): e7072. https://dx.doi.org/10.1097/MD.0000000000007072.
- Кочеткова М.В., Сюткина И.П., Королева Е.Г., Смагин А.А., Хабаров Д.В., Демура А.Ю. Использование карбоксимальтозата железа и транексамовой кислоты при органосохраняющих операциях в гинекологической практике. Современные проблемы науки и образования. 2017; 5: 118. [Kochetkova M.V., Syutkina I.P., Koroleva E.G., Smagin A.A., Khabarov D.V., Demura A.Yu. The use of iron carboxymaltose and tranexamic acid in organ-preserving operations in gynecological practice. Modern Problems of Science and Education. 2017; (5): 118. (in Russian)].
- Жорова В.Е. Терапия железодефицитной анемии у пациенток гинекологического профиля. Медицинский совет. 2019; 7: 148-52. [Zhorova V.E. Therapy of iron-deficiency anemia in gynecological patients. Medical Council. 2019; (7): 148-52. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2019-7-148-152.
Received 28.08.2023
Accepted 20.03.2024
About the Authors
Irina P. Siutkina, PhD, Researcher, Surgical Lymphology and Lymphodetoxication Laboratory, Department of Anesthesiology and Intensive Care, Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia, komarok777@mail.ru, https://orcid.org/0000-0002-3941-4521Alexander Yu. Demura, Researcher, Surgical Lymphology and Lymphodetoxication Laboratory, Department of Anesthesiology and Intensive Care, Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia, dx_@bk.ru,
https://orcid.org/0000-0001-8470-5400
Fedor A. Rakitin, Head of the Department of Gynecology, Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia, rakitinfedorr@mail.ru
Marya V. Kochetkova, PhD, Researcher, Surgical Lymphology and Lymphodetoxication Laboratory, Department of Anesthesiology and Intensive Care, Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia,
masha0112@mail.ru, https://orcid.org/0000-0002-8752-4151
Dmitriy V. Khabarov, Dr. Med. Sci., Leading Researcher of Surgical Lymphology and Lymphodetoxication Laboratory, Head of the Department of Anesthesiology and Intensive Care, Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russia; Professor, Department of Anesthesiology, Novosibirsk State University, hdv@ngs.ru, https://orcid.org/0000-0001-7622-8384
Similar Articles
