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Surgical implications of hypercoagulable syndromes
D R Gable1, T M Bergamini, C K Livingston
1Department of Surgery, University of Louisville, Kentucky 40292, USA.
The American Surgeon
|February 1, 1997
Summary
Primary hypercoagulability, a condition causing blood clots, affects surgical patients. Early diagnosis and chronic anticoagulation are recommended, but arterial reconstruction often fails.
Area of Science:
- Vascular Surgery
- Hematology
- Internal Medicine
Background:
- Improved diagnostic tests have increased recognition of primary hypercoagulability in surgical patients.
- This condition presents with venous or arterial thrombosis, often early in life and without apparent cause.
Purpose of the Study:
- To review the clinical presentations, diagnostic findings, and treatment outcomes of patients with primary hypercoagulability.
- To highlight the challenges in managing these patients and inform surgical decision-making.
Main Methods:
- Retrospective review of 20 patients with documented primary hypercoagulability treated between 1975 and 1995.
- Analysis of clinical presentations, thrombotic events (venous and arterial), underlying deficiencies in anticoagulant proteins, and treatment outcomes.
Main Results:
- Common deficiencies included antithrombin III, protein C, protein S, lupus anticoagulant, and anticardiolipin antibody.
- Vascular reconstructions in 5 patients (12 procedures) had a high failure rate (11/12).
- Three deaths were directly attributed to thrombotic complications.
Conclusions:
- Primary hypercoagulable syndromes should be suspected in patients with unexplained or early-onset thrombosis.
- Chronic anticoagulation is generally indicated, but arterial reconstruction typically yields poor outcomes.
- Surgical teams must be aware of this condition for appropriate patient evaluation and management.