Abstract
Purpose
To investigate perioperative coagulation in morbidly obese (MO) patients with the thromboelastograph (TEG) and Sonoclot analyzer.
Methods
Twenty-six consecutive morbidly obese and 26 consecutive lean patients presenting for elective surgery were enrolled in this prospective, observational study. Blood was sampled for TEG and Sonoclot analysis immediately after anaesthetic induction and at the end of surgery in the MO group, and immediately after anaesthetic induction in the lean group. The R and K times, alpha angle, maximum amplitude and percentage fibrinoiysis at 30 and 60 min were recorded from the TEG. The Sonoclot ACT, initial clot rate, peak amplitude and time to peak amplitude were recorded from the Sonoclot.
Results
The TEG in the MO group demonstrated decreased R and K times (8.6 ± 4.8 vs 11.7 ± 3.9 mm, and 2.8 ± 1.2 vs 3.5 ± 0.9 mm respectively (P < 0.05)), and increased alpha angle (73.7 ± 6.0 vs 66.7 ± 6.0°, P < 0.05) and maximum amplitude (72.0 ± 5.4 vs 67.9 ± 4.4 mm, P < 0.05), without change in fibrinolysis. Sonoclot variables in the MO group included increased clot rate (37.5 ± 11.5 vs 23.9 ± 7.7%, P < 0.05) and decreased time to peak impedance (11.7 ± 5.0 vs 17.5 ± 7.2 min, P < 0.05), without change in Sonoclot ACT or peak signature impedance.
Conclusion
The MO group demonstrated accelerated fibrin formation, fibrinogen-platelet interaction, and platelet function compared with lean controls but no difference in fibrinolysis. Viscoelastic measures of coagulation may be useful in MO patients, who are at increased risk of thromboembolic events.
Résumé
Objectif
Examiner le bilan hémostatique de patients pathologiquement obèses par thromboélastographie (TÉG) et analyse Sonoclot.
Méthodes
Consécutivement, 26 sujets obèses pathologiques (OP) et 26 sujets maigres programmés pour une chirurgie élective ont participé à cette étude prospective et observationnelle. Chez les obèses, du sang a été prélevé pour l’analyse par TÉG et par Sonoclot immédiatement après l’induction de l’anesthésie et à la fin de la chirurgie et, chez les sujets maigres, immédiatement après l’induction. Les temps R et K, l’angle alpha, l’amplitude maximale et le pourcentage de fibnnolyse à 30 et 60 min ont été enregistrés par TÉG. L’ACT la vitesse initiate de formation du caillot, l’amplitude maximale et le temps d’amplitude maximale ont été enregistrés au Sonoclot.
Résultats
Dans le groupe OP, la TÉG a révélé une baisse des temps R et K (respectivement 8,6 ± 4,8 vs 11,7 ±3,9 mm et 2,8 ± 1,2 vs 3.5 ± 0,9 mm, P < 0,05) et une augmentation de l’angle alpha (73,7 ± 6,0 vs 66,7 ± 6,0°, P < 0,05) et de l’amplitude maximale (72,0 ± 5,4 vs 67,9 ± 4,4 mm, P < 0,05) sans changement fibrinolytique. Au Sonoclot, dans le groupe OP, on observait une augmentation de la vitesse de formation du caillot (37,5 ± 11,5 vs 23,9 ± 7,7%, P < 0,05) et une diminution du temps d’impédance maximale (11,7 ± 0,5 vs 17,5 ± 7,2 min, P < 0,05) sans changement à l’ACT Sonoclot ou à l’impédance maximaie de signature.
Conclusion
Dans groupe OP, la formation de fibrine, l’interaction fibrinogène-plaquettes et la fonction plaquettaire sont accélérées comparativement aux contrôles maigres alors que la fibrinolyse est identique. Les mesures viscoélastiques de la coagulation peuvent être utiles chez les obèses pathologiques qui sont à risque d’accidents thromboemboliques.
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Pivalizza, E.G., Pivalizza, P.J. & Weavind, L.M. Perioperative thromboelastography and sonoclot analysis in morbidly obese patients. Can J Anaesth 44, 942–945 (1997). https://doi.org/10.1007/BF03011965
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DOI: https://doi.org/10.1007/BF03011965