Medical News
/ Published on January 1, 2002
Cirugía gástrica
Coagulación sistémica y fibrinolisis después de bypass gástrico
El bypass gástrico laparoscópico induce a un estado de hipercoagulabilidad similar al del bypass abierto. Los hallazgos de los autores sugieren que la profilaxis de la trombosis venosa profunda debe ser utilizada durante ambas modalidades de cirugía.
Fuente: Arch Surg. 2001; 136: 909-916
Se registraron los niveles basales y a las 1, 24, 48 y 72 horas postoperatorias de plasminógeno, complejo trombina-antitrombina, fracción de protrombina (F1.2), fibrinógeno, D-dimer, antitrombina III y proteína C. Se realizó un eso-doppler de ambas extremidades inferiores preoperatoriamente y entre el 3° y 5° días postoperatorios.
Los niveles de plasminógeno descendieron y los del complejo trombina-antitrombina, F1.2 y fibrinógeno aumentaron después de ambas variantes del mismo procedimiento. Los niveles de D-dimer se elevaron en ambos pero con un aumento significativo mayor en el bypass abierto [p< 0.01]. Los niveles de antitrombina III y de proteína C disminuyeron en los 2 grupos pero dicho descenso fue significativamente menor después del procedimiento por vía laparoscópica [p< 0.05]. El ultrasonido reveló 1 TVP (2.9%) en el grupo de cirugía abierta y ninguna en el laparoscópico y 1 enfermo del grupo abierto desarrolló un embolismo pulmonar.
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