Abstract
Purpose. The description of the alterations in the hemostatic system in children undergoing abdominal surgery is sparse. Enhanced clinical outcomes for previously untreatable conditions have led to an increased incidence of venous thromboembolic complications. Alterations in children's coagulation system during major abdominal operations compared to minor procedures were examined. Methods. Children (0–12 years) undergoing either laparotomy, thoracotomy, or minor surgery were included. Participants were divided into two groups: group 1 was open laparotomy including operations for solid abdominal tumours and thoracotomy, while group 2 was minor surgery. Activated partial thromboplastin time (aPTT), D-dimer, INR, and fibrinogen were measured. Results. Both groups had a shorter aPTT, higher INR, and lower fibrinogen concentrations after the operation, while D-dimer was unaltered. The changes were, however, discrete and probably not clinically significant. On day 3, all parameters except aPTT in group 1 (not measured in group 2) indicated a continuous coagulation activity. Conclusion. The tendency for coagulation activity altered based on the length and degree of surgery. A continuously altered activity was observed compatible with the reported increased risk of venous thromboembolism at day 3. However, before introducing thromboprophylaxis guidelines larger series of multicentre studies are needed.
Highlights
The knowledge on alterations in the coagulation system in children undergoing major surgery is sparse [1]
Participants were divided into two groups: group 1 was open laparotomy including operations for solid abdominal tumours and thoracotomy, while group 2 was minor surgery
It is generally accepted that children do not need prophylactic anticoagulant therapy because venous thromboembolic (VTE) complications are rarely seen in comparison to adults undergoing similar operations [6]
Summary
The knowledge on alterations in the coagulation system in children undergoing major surgery is sparse [1]. Plasma concentrations of most pro- and anticoagulant proteins are low during childhood compared with adult reference values [7], but these differences are thought mainly to be due to an age-related physiological difference and not an indication of any pathological process [1, 8]. Due to advances in treatment and improved clinical results in children, who survive primary diseases with a previously fatal outcome, the incidence of VTE in paediatric patients has increased [9,10,11], most often caused by a combination of an underlying clinical condition and risk factors [12].
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