Thromboprophylaxis with dalteparin after laparoscopic cholecystectomy

Background: Deep venous thrombosis (DVT) reaches a high incidence after abdominal surgery and occurs in up to 30 % of the patients operated. During the laparoscopic procedures, the intraabdominal pressure is elevated due to the pneumoperitoneum. Thromboembolic complications, including the portal vein thrombosis, have been reported in the literature, previously. The application of the low molecular weight heparins (LMWHs) enables deep venous thrombosis prevention. Material and methods: In the period from May 2001 to April 2002, a cohort of 212 patients was scheduled for an elective laparoscopic cholecystectomy, in a Clinical (high-volume) Hospital. In 30 patients with the identified risk factors, Dalteparin sodium (2500 IU or 5000 IU) was administered subcutaneously. During the first 30 postoperative days, a clinical follow-up was done for the whole cohort. All complications, as well as thromboembolic events, have been documented. Results: There were no major complications observed. Five patients had an intraabdominal (subhepatic) hemathoma and two of them were reoperated. The evacuation of the haemathoma and a drainage was done. There were no bile duct lesions. None of the patients had the clinical signs of deep venous thrombosis or other thromboembolic complications. One unplanned readmission to the hospital (patient reoperated for an intraadbominal haemathoma) was recorded. Conclusion: Dalteparin sodium proved to be effective in preventing the trhomboembolic complications after laparoscopic cholecystectomy. Selective application, according to the defined risk factors, gives very good clinical results in everyday practice.