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External pneumatic compression does not increase urokinase plasminogen activator after abdominal surgery.
Maki Murakami1, Lara A Wiley, Lori Cindrick-Pounds
1Section of Vascular Surgery, Department of Surgery, and the Office of Biostatistics, University of Texas Medical Branch, Galveston 77555, USA.
Journal of Vascular Surgery
|November 8, 2002
Summary
External pneumatic compression (EPC) devices do not increase urokinase plasminogen activator (uPA) levels, a key factor in fibrinolysis. This study suggests EPC devices primarily prevent deep venous thrombosis (DVT) by reducing venous stasis, not by enhancing the body's natural clot-dissolving mechanisms.
Area of Science:
- Vascular Surgery
- Hematology
- Thrombosis Research
Background:
- External pneumatic compression (EPC) devices are widely used for deep venous thrombosis (DVT) prophylaxis.
- A common belief is that EPC enhances endogenous fibrinolysis, but evidence is lacking.
- Previous studies did not confirm enhanced fibrinolysis with tissue plasminogen activator or its inhibitor.
Purpose of the Study:
- To investigate the hypothesis that EPC devices increase urokinase plasminogen activator (uPA) levels.
- To evaluate the effect of EPC devices on systemic and regional uPA levels in patients undergoing major abdominal surgery.
- To compare the impact of EPC devices versus unfractionated heparin on uPA levels for DVT prophylaxis.
Main Methods:
- Prospective randomized trial with 44 subjects undergoing major abdominal surgery.
- Three groups: unfractionated heparin, thigh-length sequential EPC devices, or both.
- Measurement of systemic and regional uPA levels via enzyme-linked immunoassay at multiple time points before and after surgery.
Main Results:
- No significant changes in uPA levels were observed post-surgery in any group.
- No significant differences in systemic or regional uPA levels were found between EPC and heparin groups.
- Baseline uPA levels were similar across all treatment groups.
Conclusions:
- EPC devices do not appear to enhance fibrinolysis through increased uPA levels.
- The primary mechanism of DVT prophylaxis with EPC devices is likely the reduction of venous stasis.
- Further research is needed to fully understand the role of EPC in fibrinolysis and DVT prevention.