Inaccurancies of Clotting Tests in Early Diagnosis of Post-Operative Deep Vein Thrombosis (D. V. T.)

Two groups of pneumonectomized patients with diagnosis of pulmonary carcimona were successively studied to assess the diagnostic and predictive values of some clotting test in post-operative D. V. T. The incidence of D. V. T. was determined by the ¹²⁵I fibrinogen method. Simultaneously blood clotting tests including thromboelastography (T.E.G.), P.T.T. platelet count, fibrinogen level, F. D. P. assay, ethanol test were performed both before and after the surgical procedure on the 2^d, 4^th, a.nd 7^th post-operative days. The first group (32 patients) received subcutaneous Heparin beginning on the third post-operative day. The dose (5000 to 10000 u T. I. D.) was adapted according to the results of the T. E. G. in an efford to obtain an isocoagulable state. The second group (45 patients) received 5000 u of heparin subcutaneously (B. I. D.) with the first injection two hours before the surgical procedure: the dose was adapted on the third day according to the T. E. G.

The results of this study show: (1) The frequency of blood clotting disturbances is similar in both groups in spite of pre-operative heparinotherapy. (2) The first group presented five D. V. T. and two fatal pulmonary embolisms whereas the second group presented only three D. V. T. (P < 0,1). (3) There is no correlation between a positive scanning of the lower limbs and blood clotting disturbances.

In conclusion, clotting disturbances seem to be related to either to surgical procedure or to the carcimona. D. V. T., at early stage, appears to be a local phenomenon which in itself is unable to perturb peripheral blood clotting tests.

(Supported in part by a Grant of Inserm: ATP-12-74-33.)