PERSONALIZATION IN ONCOLOGY: INDIVIDUAL APPROACH TO THE PREVENTION OF THROMBOEMBOLIC COMPLICATIONS DURING HYSTERECTOMY
DOI:
https://doi.org/10.11603/1681-2786.2018.4.9875Keywords:
prophylaxis of thromboembolic complications, individual approach, hysterectomy, endometrial cancerAbstract
Purpose: to increase the efficiency of surgical treatment of patients with endometrial cancer by optimizing diagnostic tactics and surgical prophylaxis of thrombotic complications in the early postoperative period.
Materials and Methods. Three groups of women were examined: І – group of 30 somatic healthy women; ІІ – control group (comparison group) – 120 cards of patients with endometrial cancer was analyzed retrospectively, which was surgical treatment in the period of 2010–2013; III – is the main group of women with endometrial cancer who underwent surgical intervention (hysterectomy) – 147 patients who were on surgical treatment in 2014–2017.
Results. At the first stage of our study, the main anthropometric characteristics of the examined women and the risk VTE on the J. Caprini scale were analyzed. In the main group of patients and in the comparison group, there was an increased risk of developing thromboembolism compared with a group of healthy individuals, indicating a high and very high risk of their occurrence at the surgical stage of treatment.
The study of hemostatic parameters in the main group and the comparison group in the preoperative, intraoperative and early postoperative period revealed hypercoagulation with signs of intravascular coagulation, manifested by a significant decrease in the prothrombin index and reduction of PT and APTT, with simultaneous increase in the level of FG, and D-dimer. Signs of hypercoagulation increased during the operation and for 1–5 days after the postoperative period and gradually decreased to preoperative values, with the exception of the D-dimer, whose peak was observed at the 8th day of postoperative period.
The algorithm of optimization of diagnostic and surgical prophylaxis of thromboembolism in patients with endometrial cancer, taking into account the risk of their occurrence, was created and implemented in the practice of health care.
Conclusions. 1. The reduction in mortality in the early postoperative period in patients with endometrial cancer from PE was 4,17 % to 0 % and postoperative thrombotic complications – from 11,67 % to 1,36 %.
- The algorithm for optimization of diagnostic tactics and surgical prophylaxis of possible VTE in patients with endometrial cancer is developed and implemented in the clinical practice, taking into account the state of activity of the hemostasis system and anthropometric data and motivated practical recommendations provided.
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