THE EFFECT OF ELEVATED BODY MASS INDEX (BMI) ON THE LEVEL OF THROMBOSIS IN LAPAROSCOPIC MYOMECTOMY

Abstract

Uterine fibroids are one of the most common diseases in gynaecological practice. Laparoscopic myomectomy is one of the main methods of surgical treatment of uterine fibroids in women of reproductive age. According to the WHO data, overweight is considered to be BMI 25 and above, BMI 30 and above means obesity. The association of obesity with Intravascular Thrombotic Complications (ITC) is confirmed by clinical data. To date, there is a fairly significant set of cloning, enzyme- linked immunosorbent assays for the assessment of the Aggregate State Blood Regulation (RASC) system, the results of which give only a very approximate description of haemostatic potential. Therefore, instrumental methods of assessing haemostasis are of particular importance. Low-Frequency Piezoelectric Thromboelastography (LPTEG) is the most effective method of Haemostatic Potential (HP), able to objectively display the vascular-platelet component, the coagulation link of the haemostasis system and fibrinolysis. This technology allows you to visualize the process of blood clotting, allows you to assess in real-time all phases of coagulation and quantify the intensity of procoagulant potential and anticoagulant potential. Objectives. To study the effect of elevated body mass index on the level of thrombosis for adequate complex thromboprophylaxis in patients in the perioperative period with laparoscopic myomectomy, using an instrumental method of diagnosis as a low-frequency piezoelectric hemiscosimeter. Materials and Methods. The results of surgical treatment of 60 patients with uterine fibroids who underwent laparoscopic myomectomy at MOTHER AND CHILD, Medical Centre; NEOMED 2007, LLC in Kyiv in 2019-2020 were studied. Patients were divided into 2 groups depending on the value of BMI. Group 1 (16 patients) included patients with BMI < 30 kg/m2. Group 2 (44 patients) included patients with BMI > 30 kg/m2. The state of the haemostatic system before surgery, as well as on the 1st and 5th days after surgery, was monitored by standard biochemical tests, as well as by an instrumental method for assessing the functional state of the components of the haemostatic and fibrinolysis system as a Low-Frequency Vibration Piezoelectric Hemoviscosimeter (LFVPH). Results. After evaluating standard biochemical tests for assessing haemostasis before surgery, on Day 1 and Day 5 after surgery, no existing or significant pathological changes were detected in all groups of patients. When assessing the functional status of the components of the haemostasis and fibrinolysis system with Mednord LFVPH before surgery in Group 1 (Control Group of Patients), there were no significant differences within normal limits. In Group 2, statistically significant (p < 0.05) deviations from the reference values of haemostasiogram in the direction of structural and chronometric hypercoagulation, increased thrombin activity, activation of vascular-platelet haemostasis, inhibition of the lytic activity of blood. On the first day after surgery, changes in the haemostasis system were observed in both groups of patients. In Group 1 of patients, there was a decrease in chronometric parameters and an increase in the structural parameters of LPTEG, but they did not exceed the reference values. In Group 2, there was a significant decrease (compared to preoperative indicators) in chronometric indicators, an increase in structural indicators of Maximum Amplitude (MA), as well as a significant increase in Constant Thrombin Activity (CTA), Intensity of Coagulation Drive (ICD), indicating an increase in thrombosis in this group of patients requiring thromboprophylaxis. After thromboprophylaxis, changes in the normocoagulation trend of Haemostatic Potential (HP) were observed in the Group 2 patients. Fibrinolytic activity of blood before surgery is within the lower reference values in Group 1, and there is suppression of the lytic activity of blood in Group 2. One day after surgery, on the background of antithrombotic therapy, the lytic activity of the blood is normalized. On the 5th day after surgery, a normocoagulation tendency of haemostatic potential was observed in all groups of patients. Conclusions. In patients with uterine fibroids with BMI> 30, using the Mednord ARP-01M hardware-software set, revealed the presence of thrombosis in the perioperative stage of laparoscopic myomectomy, as evidenced by significantly significant (p < 0.05) changes in the main indicators of haemoscosimetry. Standard screening methods for the study of the hemostasis system do not provide a rapid and adequate assessment of Haemostatic Potential (HP), the response of the ASBR system in response to surgery, and do not allow to fully assess the functional activity of the vascular-platelet coagulation and fibrinolysis. The use of low-frequency piezoelectric haemoviscosimetry allows to reliably and quickly assess the kinetics of thrombosis, from initial viscosity and aggregation to clot formation and fibrinolysis, as well as to detect haemocoagulation disorders in patients with uterine fibroids in the earliest stages of myocardial infarction. This allows timely and effective prevention and treatment of thrombohemorrhagic disorders in this group of patients.