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[Hemostatic changes in patients with peripheral artery disease before and after bypass surgery]
R E Kalinin1, I A Suchkov1, N D Mzhavanadze1
1Pavlov Ryazan State Medical University of Healthcare Ministry of Russia, Ryazan, Russia.
Insights
Peripheral artery disease (PAD) patients exhibit a prothrombotic state, particularly after bypass surgery. This study assessed coagulation factors and endothelial dysfunction markers before and after surgery.
Area of Science:
- Vascular Surgery
- Hematology
- Endothelial Function
Background:
- Peripheral artery disease (PAD) is characterized by impaired blood flow to the limbs.
- Endothelial dysfunction and a prothrombotic state are associated with PAD progression.
- Surgical intervention for PAD aims to restore blood flow but may impact hemostasis.
Purpose of the Study:
- To evaluate intrinsic coagulation pathway factor activity in PAD patients.
- To assess hemostatic markers of endothelial dysfunction before and after lower extremity bypass surgery.
- To compare the hemostatic changes between surgical intervention and medication management.
Main Methods:
- 80 patients with PAD (Fontaine grade IIB-III) were divided into surgical (n=40) and medication (n=40) groups.
- Blood samples were collected preoperatively and 3 months postoperatively.
- Assessed were factors VIII, IX, XI, von Willebrand factor (VWF), protein C (PrC), and nitric oxide (NO) metabolites.
Main Results:
- Preoperatively, group A showed increased activity of factors VIII, IX, XI, and VWF.
- Post-surgery, group A exhibited further increases in factors VIII and VWF, with persistent elevation of IX and XI alongside reduced NO metabolites.
- Group B demonstrated increased activity of IX, XI, and VWF, with normal NO metabolites and PrC levels.
Conclusions:
- PAD is associated with a prothrombotic state, exacerbated by surgical procedures.
- Lower extremity bypass surgery leads to more pronounced hypercoagulation compared to medication alone.
- These findings highlight the complex hemostatic alterations in PAD patients undergoing treatment.
Aim:
To assess intrinsic coagulation pathway factors activity and hemostatic markers of endothelial dysfunction in patients with peripheral artery disease (PAD) before and after lower extremity bypass surgery.
Material And Methods:
80 patients with PAD Fontaine grade IIB-III were enrolled. 40 patients underwent open aorto-femoral-popliteal repair (group A) and 40 patients - medication (group B). Before and in 3 months after surgery peripheral venous blood samples were collected to assess the activity of factors VIII, IX, XI, von Willebrand factor (VWF), protein C (PrC), and metabolites of nitric oxide II (NO).
Results:
Increased preoperative activity of VIII, IX, XI, and VWF factors compared with normal values was observed in group A. After 3 months there was an additional increase of VIII and VWF factors' activity. Activity of IX and XI factors remained increased on background of reduced level of NO metabolites. In group B increased activity of IX, XI, and VWF factors was revealed while levels of NO metabolites and PrC were normal.
Conclusion:
Thus, PAD is followed by prothrombotic state especially in patients after surgery. Surgical procedures are associated with more severe hypercoagulation.
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