Impact of Arterial Procedures on Coagulation and Fibrinolysis - A Pilot Study.
OBJECTIVE
The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways.


METHODS
We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate < 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure.


RESULTS
Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P<0.001), antithrombin (92.1 vs. 74.8, P<0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P<0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21).


CONCLUSION
Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.
['Polok|Kamil Jurand|KJ|', 'Górka|Jacek|J|', 'Fronczek|Jakub|J|', 'Górka|Karolina|K|', 'Kaczmarek|Bogusz|B|', 'Iwaniec|Teresa|T|', 'Iwaszczuk|Paweł|P|', 'Musiał|Jacek|J|', 'Szczeklik|Wojciech|W|']
D000368:Aged D017544:Aortic Aneurysm, Abdominal D015415:Biomarkers D001777:Blood Coagulation D001779:Blood Coagulation Factors D004797:Enzyme-Linked Immunosorbent Assay D005260:Female D005342:Fibrinolysis D006801:Humans D008297:Male D008875:Middle Aged D058729:Peripheral Arterial Disease D010865:Pilot Projects D011184:Postoperative Period D057234:Preoperative Period D012016:Reference Values D012307:Risk Factors D018709:Statistics, Nonparametric D016896:Treatment Outcome D014656:Vascular Surgical Procedures
Blood Coagulation/Anticoagulation Fibrin/Fibrosis/Fibrinolysis Vascular Surgical Procedures