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Perioperative activation of hemostasis in vascular surgery patients
C M Samama1, D Thiry, I Elalamy
1Department of Anesthesiology, Centre Hospitalier Universitaire Avicenne, Univeristé Paris 13, Bobigny, France. cmsamama@invivo.edu
Insights
Postoperative vascular surgery patients show increased platelet activation and impaired fibrinolysis, suggesting a higher risk of blood clots. This highlights the importance of monitoring hemostasis during and after major surgery.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Vascular Surgery
Background:
- Perioperative hemostasis activation may contribute to postoperative cardiac events.
- Assessing hemostatic status is crucial in patients undergoing major vascular surgery.
Purpose of the Study:
- To prospectively evaluate platelet function, coagulation, and fibrinolysis in patients during and after infrarenal aortic surgery.
- To identify potential hemostatic changes that may increase thrombotic risk.
Main Methods:
- Prospective study of 17 patients undergoing infrarenal aortic surgery.
- Blood samples collected at multiple time points: preoperatively, intraoperatively, and up to 7 days postoperatively.
- Assessed platelet count, aggregation, flow cytometry (CD62, CD63), coagulation tests, thrombin-antithrombin complexes, and plasminogen activator inhibitor 1.
Main Results:
- Postoperatively, increased adenosine diphosphate-induced platelet aggregation was observed, but flow cytometry showed no platelet activation.
- Elevated fibrinogen levels and increased plasminogen activator inhibitor 1 were detected, indicating impaired fibrinolysis.
- Thrombin generation appeared limited, despite platelets being more prone to activation.
Conclusions:
- The combination of more easily activated platelets, higher fibrinogen, and reduced fibrinolysis suggests an increased thrombotic risk.
- These findings underscore the importance of monitoring hemostatic status in the early postoperative period after major vascular surgery.
Background:
Perioperative activation of hemostasis could play an important role in the occurrence of postoperative cardiac events. The authors conducted a prospective study to assess platelet function, coagulation, and fibrinolysis status during and after infrarenal aortic surgery.
Methods:
Seventeen patients were studied. Excluded were patients with preoperative coagulopathies or liver disease, or cardiac or renal insufficiency; patients receiving anticoagulant treatment, antiplatelet agents, nonsteroidal antiinflammatory agents, fresh frozen plasma, or platelet concentrates; and patients undergoing reoperation and septic patients. Blood samples were drawn before induction (T1), 1 h after incision (T2), 1 h after extubation (T3), 24 h postoperatively (T4), 48 h postoperatively (T5), and at day 7 (T6). The following tests were performed: platelet count, platelet aggregation, platelet flow cytometry for CD62 and CD63, usual coagulation tests, thrombin--antithrombin complexes, plasminogen activator inhibitor 1.
Results:
A significant increase of adenosine diphosphate--induced platelet aggregation was observed postoperatively at T4 and T5. This was not associated with a change of flow cytometry profile. No increase of thrombin--antithrombin complex levels was observed. A higher fibrinogen rate was detected at T5 and T6. Greater amounts of plasminogen activator inhibitor 1 were detected at T3 and T4. Thus, thrombin generation was limited and fibrinolysis was impaired postoperatively. Platelets were not activated in the postoperative period, as shown by flow cytometry, but were prone to be activated, as shown by aggregation studies.
Conclusion:
The association of more easily activated platelets with a higher fibrinogen rate and a temporary shut down of fibrinolysis during the early postoperative period may indicate an increased thrombotic risk in patients undergoing major vascular surgery.