Screening for hypercoagulable states in vascular surgical practice: a preliminary study.

Area of Science:

• Vascular Surgery
• Hematology
• Thrombosis

Background:

• Hypercoagulable states are common in the general vascular surgical population.
• The prevalence and clinical significance of these states remain largely unknown.

Purpose of the Study:

• To determine the prevalence of hypercoagulable states in vascular surgical patients.
• To investigate the association between hypercoagulable states and early graft thrombosis.

Main Methods:

• Prospective analysis of 158 patients with various vascular diseases.
• Assays for Antithrombin III, protein C, protein S, plasminogen, lupus-like anticoagulant, and heparin-induced platelet activation.
• Correlation of abnormal test results with early infrainguinal bypass graft thrombosis.

Main Results:

• 15 patients (9.5%) had abnormal test results, including deficiencies in antithrombin III, protein C, protein S, and presence of lupus-like anticoagulant or heparin-induced platelet activation.
• Early graft thrombosis occurred in 27% of patients with abnormal tests versus 1.6% with normal tests (p<0.01).
• Lupus-like anticoagulant and heparin-induced platelet activation were associated with graft thrombosis.

Conclusions:

• Hypercoagulable states are prevalent and clinically significant in vascular surgery.
• Routine preoperative screening for lupus-like anticoagulant and heparin-induced platelet activation is recommended for infrainguinal reconstruction.
• Further investigation into hypercoagulable states in vascular surgery is warranted.