Perioperative prevention of thrombohemorrhagic complications in patients with calculous cholecystitis and obstructive jaundice

The OBJECTIVE was to improve the effectiveness of prevention of thrombohemorrhagic disorders in patients with calculous cholecystitis and obstructive jaundice.

METHODS AND MATERIALS. The clinic examined 537 patients operated on for obstructive jaundice. From 2010 to 2015, the prevention of thrombohemorrhagic complications consisted in the determination of risk factors, elastic compression of the lower extremities and the appointment of anticoagulants (1st comparative group). Since 2015, all medical measures have also been carried out taking into account the stages of obstructive jaundice (2nd study group).

RESULTS. When comparing the results, the number of subhepatic abscessed hematomas decreased from 4 (1.6 %) patients in the first group to 2 (0.8 %) in the second, the number of gastric bleedings-from 6 (2.4 %) to 3 (1.2 %), metrorrhagia – from 3 (1.2 %) to 1 (0.4 %), pancreatic necrosis – from 8 (3.2 %) to 5 (1.9 %), pulmonary embolism – from 7 (2.8 %) to 5 (2.0 %), the number of strokes and transient disorders of cerebral circulation – from 5 (2.0 %) to 3 (1.2 %), the number of cardiac arrhythmias in the form of atrial fibrillation-from 3 (1.2 %) to 2 (0.8 %). The incidence of myocardial infarction decreased from 5 (2.0 %) patients to 3 (1.2 %), and the incidence of mesenteric vascular thrombosis decreased from 3 (1.2 %) to 1 (0.4 %). In group 1, 2 (0.8 %) patients had hemobilia.

CONCLUSION. In addition to protocols and standards, the prevention of thrombohemorrhagic complications should take into account the stages of obstructive jaundice. During the period of cholestasis, the prevention of thrombohemorrhagic complications should be used in the same volume as in the absence of jaundice. In hepatocytolysis, it should be performed using the CHA₂DS₂-VASc scale with the HEMORR₂HAGESscale as a safety net. In cholangitis, on the contrary, the main role is assigned to the HEMORR₂HAGESscale.

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