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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
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Published on: June 8, 2019

Activation of coagulation and fibrinolytic systems in patients with CLI is not normalized after surgical

H Pärsson1, A Holmberg, A Siegbahn

  • 1Institution for Surgical Science, Uppsala, Sweden.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|January 14, 2004
PubMed

Insights

Surgical revascularisation for critical limb ischemia (CLI) causes significant coagulation and fibrinolysis disturbances, alongside inflammatory mediator release. These prothrombotic and hyperfibrinolytic states persist for 30 days post-surgery.

Area of Science:

  • Vascular Surgery
  • Hematology
  • Critical Limb Ischemia (CLI)
  • Coagulation and Fibrinolysis

Background:

  • Critical limb ischemia (CLI) is a severe manifestation of peripheral artery disease, often requiring surgical revascularization.
  • Understanding the hemostatic and inflammatory changes associated with revascularization is crucial for managing CLI patients.

Purpose of the Study:

  • To investigate the activation of coagulation and fibrinolysis pathways.
  • To assess inflammatory mediator levels before, during, and after surgical revascularization in CLI patients.

Main Methods:

  • Prospective clinical study involving 40 CLI patients undergoing femoro-popliteal or femoro-distal reconstruction.
  • Assessed coagulation activation via prothrombin-fragment 1+2 (F1+2) and thrombin-antithrombin complex (TAT).
  • Measured fibrinolysis using tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), and D-dimer; analyzed inflammatory mediators IL-2-rec, IL-6, IL-10, and MCP-1.

Main Results:

  • Patients exhibited a preoperative prothrombotic state (high TAT) and ongoing fibrinolysis (high t-PA, D-dimer).
  • Post-reperfusion, a prothrombotic state persisted for the first week, with defective fibrinolysis (increased tPA/D-dimer unopposed by PAI-1) at one week and 30 days.
  • Elevated inflammatory mediators (IL-6, IL-10, MCP-1) were observed post-reperfusion, normalizing by 30 days.

Conclusions:

  • Surgical revascularization for CLI leads to significant, persistent disturbances in both coagulation and fibrinolytic systems.
  • These hemostatic changes are accompanied by the release of inflammatory mediators.
  • A prothrombotic state and increased fibrinolysis remain evident even 30 days after successful revascularization.
Abstract

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