Postoperative changes in hemostasis analyzed by the serial determination of fibrinopeptides and D-dimer

In order to elucidate the postoperative changes in hemostasis, three molecular markers; fibrinopeptide A (FPA), fibrinopeptide B beta 15-42 (B beta 15-42) and D-dimer, were serially determined in 27 gastric resections (group A), 27 hepatic resections (group B) and 4 probe laparotomies (group C). Unexpectedly, a postoperative hypercoagulable state was transient and of a low magnitude, as determined by the obtained value of FPA. On the other hand, a significant fibrinolysis (an elevation of B beta 15-42) was observed immediately after surgery which continued for over 10 days. The early phase of fibrinolysis, up until the 3rd postoperative day, is likely to be primary fibrinolysis, as it was not accompanied by the formation of D-dimer, which results from the digestion of fibrin by plasmin. The late phase, however, is considered to be secondary fibrinolysis, as D-dimer was elevated during this phase. Despite the different surgical procedures, these changes were basically similar between the patients who underwent gastric resections and those who underwent liver resections. The postoperative changes in hemostasis as presented herein may therefore be the general physiological response, at least against abdominal surgery.