Dynamic control of hemostasis during organ-sparing surgery in gynecologic practice

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Abstract

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.

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About the authors

Irina P. Siutkina

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Author for correspondence.
Email: komarok777@mail.ru
ORCID iD: 0000-0002-3941-4521

PhD, Researcher, Surgical Lymphology and Lymphodetoxication Laboratory, Department of Anesthesiology and Intensive Care

Russian Federation, Novosibirsk

Alexander Y. Demura

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Email: dx_@bk.ru
ORCID iD: 0000-0001-8470-5400

Researcher, Surgical Lymphology and Lymphodetoxication Laboratory, Department of Anesthesiology and Intensive Care

Russian Federation, Novosibirsk

Fedor A. Rakitin

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Email: rakitinfedorr@mail.ru

Head of the Department of Gynecology

Russian Federation, Novosibirsk

Marya V. Kochetkova

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Email: masha0112@mail.ru
ORCID iD: 0000-0002-8752-4151

PhD, Researcher, Surgical Lymphology and Lymphodetoxication Laboratory, Department of Anesthesiology and Intensive Care

Russian Federation, Novosibirsk

Dmitriy V. Khabarov

Research Institute of Clinical and Experimental Lymрhology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences; Novosibirsk National Research State University, Zelman Institute for Medicine and Psychology

Email: hdv@ngs.ru
ORCID iD: 0000-0001-7622-8384

Dr. Med. Sci., Leading Researcher of Surgical Lymphology and Lymphodetoxication Laboratory, Head of the Department of Anesthesiology and Intensive Care; Professor, Department of Anesthesiology

Russian Federation, Novosibirsk; Novosibirsk

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