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Hypercoagulable states in arterial thromboembolism.

J D Eason1, J L Mills, W C Beckett

  • 1Vascular Surgery Section, Wilford Hall USAF Medical Center, Lackland, AFB.

Surgery, Gynecology & Obstetrics
|March 1, 1992
PubMed
Summary

Hypercoagulable states, or blood clotting disorders, increase arterial thromboembolism risk. Untreated states lead to poor outcomes in vascular reconstruction, especially with prosthetics.

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Area of Science:

  • Vascular Surgery
  • Hematology
  • Thrombosis

Background:

  • Hypercoagulable states encompass anticoagulant deficiencies, fibrinolytic disorders, antiphospholipid antibodies, and platelet abnormalities.
  • These conditions are established causes of venous thromboembolism and increasingly linked to arterial thromboembolism.
  • Undiagnosed hypercoagulable states can lead to severe complications in prosthetic vascular reconstructions.

Purpose of the Study:

  • To investigate the impact of hypercoagulable states on patients undergoing vascular reconstruction.
  • To identify the prevalence and types of hypercoagulable disorders in patients with arterial thromboembolism.
  • To evaluate the outcomes of prosthetic versus autogenous vascular reconstructions in patients with hypercoagulable states.

Main Methods:

  • Retrospective analysis of 12 male patients (ages 41-62) with hypercoagulable states from 1986-1990.
  • Diagnostic evaluation included PT, PTT, platelet count, coagulation factor assays (Antithrombin III, Protein C, Protein S), and platelet aggregometry.
  • Surgical interventions involved prosthetic or autogenous vascular reconstructions.

Main Results:

  • Six of 12 patients presented with arterial thromboembolism, including ischemic rest pain, blue toe syndrome, and claudication.
  • Identified hypercoagulable states included Protein S deficiency (2), Protein C deficiency (1), combined C and S deficiency (1), and hyperaggregable platelets (2).
  • Prosthetic reconstruction in 4 patients resulted in limb loss (3) and death (1); only one graft remained patent on anticoagulation. Autogenous reconstruction in 2 patients led to successful revascularization and limb salvage.

Conclusions:

  • Hypercoagulable states pose a significant risk for arterial thromboembolism and adverse outcomes in vascular reconstruction.
  • Prosthetic vascular reconstructions are associated with high rates of failure and limb loss in patients with untreated hypercoagulable states.
  • Autogenous vascular reconstructions appear to be a safer alternative, offering better limb salvage in this patient population.

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