please help with surgery-related hemostasis question.

[fightingspirit]

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I am a second year dental student. We studied anticoagulants and their applications very briefly. I understand the importance of adequate coagulation/clotting to restore hemostasis and promote wound healing. This also explains why in most surgical procedures, the surgeon wants the pre-op patient who is on anticoagulants to reduce their anticoagulant intake. Thus, a normocoagulative state is preferred.
However, it was very briefly mentioned that heparin, an anticoagulant, is in fact used prophylactically prior to certain surgeries like orthopedic and abdominal surgeries. Here, it seems that the hypocoagulative state is preferred.

So please help me with the following questions:
1-what does the expression “abdominal surgery” mean? Is it surgery involving the GIT, or GIT plus any other organ in the abdominal cavity?
2-in what surgeries is a hypocoagulative state needed? And does this need overrides the need for proper wound healing?

help is greatly appreciated

Thank you

 

[Blade28]

Pre-op heparin is probably used for DVT prophylaxis, not for anticoagulation during the case. There are exceptions to this - e.g. during transplant, vascular or cardiothoracic procedures - but usually you're combatting the immobility of the patient during long cases and their increased risk of DVT.

Abdominal surgery usually means any operation involving the abdomen - this doesn't necessarily mean the GI tract (which I'm assuming is what you meant by "GIT"). For example, the liver, spleen, gallbladder, appendix, etc. don't necessarily involve cutting into the intestines.

 

[fightingspirit]

Pre-op heparin is probably used for DVT prophylaxis, not for anticoagulation during the case. There are exceptions to this - e.g. during transplant, vascular or cardiothoracic procedures - but usually you're combatting the immobility of the patient during long cases and their increased risk of DVT.

Abdominal surgery usually means any operation involving the abdomen - this doesn't necessarily mean the GI tract (which I'm assuming is what you meant by "GIT"). For example, the liver, spleen, gallbladder, appendix, etc. don't necessarily involve cutting into the intestines.

thank you for taking a go at this.

yes, by GIT, i meant gastrointentinal tract. as far as my heparin confusion, i am trying to understand the following phrase:
"Heparin can also be used as a subcutaneous prophylaxis before surgeries like high-risk orthopedic surgeries or abdominal surgery."
this phrase appeared in a transcript on anticoagulants, here at the medical school (i take classes with meds...)....

once again, thanks for givin' it a shot

 

[Blade28]

thank you for taking a go at this.

yes, by GIT, i meant gastrointentinal tract. as far as my heparin confusion, i am trying to understand the following phrase:
"Heparin can also be used as a subcutaneous prophylaxis before surgeries like high-risk orthopedic surgeries or abdominal surgery."

Seems like they're stating that subcutaneous heparin is used for DVT prophylaxis pre-operatively.

I'm not sure why you're confused - am I missing something here? 😕

 

[SocialistMD]

thank you for taking a go at this.

yes, by GIT, i meant gastrointentinal tract. as far as my heparin confusion, i am trying to understand the following phrase:
"Heparin can also be used as a subcutaneous prophylaxis before surgeries like high-risk orthopedic surgeries or abdominal surgery."
this phrase appeared in a transcript on anticoagulants, here at the medical school (i take classes with meds...)....

once again, thanks for givin' it a shot

It is just what Blade said; these patients are at a higher risk for developing a deep venous thrombus, usually a result of immobility postoperatively, manipulation of vessels near the operative site or malignancy (which puts them in a baseline hypercoagulable state). Many patients who have either orthopedic or GI malignancy procedures (colorectal comes to mind most) receive low-dose anticoagulation prior to surgery to decrease the risk of venous thrombosis.

 

[fightingspirit]

It is just what Blade said; these patients are at a higher risk for developing a deep venous thrombus, usually a result of immobility postoperatively, manipulation of vessels near the operative site or malignancy (which puts them in a baseline hypercoagulable state). Many patients who have either orthopedic or GI malignancy procedures (colorectal comes to mind most) receive low-dose anticoagulation prior to surgery to decrease the risk of venous thrombosis.

i understand. but would that heparin not affect their wound healing?

 

[tussy]

Subcutaneous heparin (usually 5000u given an hour before the beginning of the case and then twice daily until discharge) gives good prophylaxis against deep vein thrombosis and does not increase surgical bleeding. During very high risk cases they may even use low-molecular weigh heparin in lower doses which will increase surgical bleeding somewhat but the risk is outweighed by preventing DVTs.

Does this answer your question????

 

[SocialistMD]

i understand. but would that heparin not affect their wound healing?

It doesn't really play a role in wound healing as much as it might increase the risk of post-op hemorrhage.

 

[fightingspirit]

Subcutaneous heparin (usually 5000u given an hour before the beginning of the case and then twice daily until discharge) gives good prophylaxis against deep vein thrombosis and does not increase surgical bleeding. During very high risk cases they may even use low-molecular weigh heparin in lower doses which will increase surgical bleeding somewhat but the risk is outweighed by preventing DVTs.

Does this answer your question????

yes, that answers it pretty well. i was especially looking for this part "does not increase surgical bleeding."....

thank you very much

 

[Winged Scapula]

yes, that answers it pretty well. i was especially looking for this part "does not increase surgical bleeding."....

thank you very much

Just to clarify since tussy noted that pre-op Heparin DOES increase post-op surgical bleeding but its benefit of preventing DVT is worth the risk.

Post-op bleeding may not be significant or it can be a real disaster, as I understand it can be in dental cases.

 

[fightingspirit]

Just to clarify since tussy noted that pre-op Heparin DOES increase post-op surgical bleeding but its benefit of preventing DVT is worth the risk.

Post-op bleeding may not be significant or it can be a real disaster, as I understand it can be in dental cases.

thank you very much.