To Evaluate Role of Thromboembolism Prophylaxis During Laparoscopic Surgery: A Prospective Observational Study
Keywords:
venous thromboembolism, venous thromboembolism, laparoscopic surgery, laparoscopic surgery, low molecular weight heparin, low molecular weight heparin, prophylaxis, prophylaxis, deep vein thrombosis, deep vein thrombosis, pulmonary embolism, pulmonary embolismAbstract
Background: Venous thromboembolism (VTE) remains a leading cause of preventable postoperative morbidity. Although laparoscopic surgery reduces surgical trauma, pneumoperitoneum and patient positioning may predispose to VTE.
Methods: We conducted a prospective observational study at a tertiary‑care centre in India between November 2022 and May 2024. Sixty patients undergoing elective laparoscopic surgery were divided into a prophylaxis group (enoxaparin 30 mg subcutaneous daily for 7 days; n = 30) or a control group with no chemoprophylaxis (n = 30). All participants were mobilised early and received mechanical prophylaxis as needed. Patients were followed for 30 days; symptomatic individuals underwent duplex ultrasonography or computed‑tomography pulmonary angiography for confirmation.
Results: Between the treatment groups there were no significant differences regarding American Society of Anesthesiologists grade, age, sex distribution and body mass index. Overall VTE incidence was 3.3 % (2/60). Of all recorded cases of VTE both events developed among patients from the non-prophylaxis cohort where the cumulative incidence amounted to 6.7 percent and zero percent respectively (p value =0.15). This translates into 6.7 percent absolute risk reduction with a required 15 patients for treatment. The recipients of enoxaparin did not experience any severe or clinically important bleeding incidents either major or non-major. Both groups required similar durations of hospitalization (3 days with IQR of 3–4) for their healthcare stays.
Conclusion: A brief administration of fixed-dose low molecular weight heparin decreased symptomatic VTE after laparoscopic procedures without generating additional bleeding risks. The use of routine risk assessment together with selected chemoprophylaxis treatment seems proper for improving patient protection without excessive treatment consumption. More significant research with multiple hospitals should investigate these findings to establish proper medication prevention periods for various populations undergoing laparoscopic procedures.
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