Impact of Arterial Procedures on Coagulation and Fibrinolysis – A Pilot Study

Polok, Kamil; Górka, Jacek; Fronczek, Jakub; Górka, Karolina; Kaczmarek, Bogusz; Iwaniec, Teresa; Iwaszczuk, Paweł; Musiał, Jacek; Szczeklik, Wojciech

doi:10.21470/1678-9741-2018-0238

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Consistently, the sCD40L levels were lower in patients with prior CABG compared with those without, among patients with CAD in this sample [ 12 ]. Immediately after CABG and LE surgical revascularization, an increase in the sCD40L levels has been reported, probably related to the surgical procedure [ 46 , 47 ]. The lower levels of sCD40L that we observed in the long term after LE revascularization is a novel finding, which may add to the knowledge on the pathophysiology of revascularization procedures and inflammation in stable atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

The Proinflammatory Soluble CD40 Ligand Is Associated with the Systemic Extent of Stable Atherosclerosis

et al. 2021

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Background and objectives: Polyvascular atherosclerosis is frequent and associated with a high cardiovascular risk, although the mechanisms regulating the atherosclerosis extent to single or multiple arterial territories are still poorly understood. Inflammation regulates atherogenesis and soluble CD40 ligand (sCD40L) is an inflammatory mediator associated with the presence of single-territorial atherosclerosis. We assessed whether the sCD40L expression is associated with the atherosclerosis extent to single or multiple arterial territories and with the atherosclerosis severity in different territories. Materials and Methods: We prospectively enrolled 94 participants with no atherosclerosis (controls, n = 26); isolated coronary atherosclerosis (group 1, n = 20); coronary and lower extremity (LE) atherosclerosis (group 2, n = 18); coronary and carotid atherosclerosis (group 3, n = 12); and coronary, LE, and carotid atherosclerosis (group 4, n = 18). Serum sCD40L levels were quantified. Results: The sCD40L levels (ng/mL, mean (standard deviation)) were 4.0 (1.5), 5.6 (2.6), 7.2 (4.2), 5.9 (3.7), and 5.1 (2.4) in controls and groups 1 to 4, respectively (ANOVA p = 0.012). In nonrevascularized patients, the sCD40L levels were significantly higher in group 2 than in group 1 and were correlated with the number of LE diseased segments. Prior LE bypass surgery was associated with lower sCD40L levels. Coexistence of coronary and LE atherosclerosis was independently associated with the sCD40L levels. Conclusions: The sCD40L levels were increased in stable atherosclerosis, particularly in polyvascular coronary and LE atherosclerosis. The number of LE diseased segments and prior LE revascularization were associated with sCD40L expression. To our knowledge, these are novel data, which provide insights into the mechanisms underlying multi-territorial atherosclerosis expression. sCD40L may be a promising noninvasive tool for refining the stratification of the systemic atherosclerotic burden.

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Section: Discussionmentioning

confidence: 99%

The Proinflammatory Soluble CD40 Ligand Is Associated with the Systemic Extent of Stable Atherosclerosis

et al. 2021

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“…2 The analysis of changes in the fibrinolytic system also presents a very complicated picture. Polok et al 36 observed a perioperative increase in D-dimer and tPA antigen levels, but without any change between pre-and postoperative levels of plasmin-antiplasmin complexes in patients undergoing surgery for abdominal aortic aneurysm or peripheral artery disease. The authors concluded that vascular surgery leads to significant alterations in the hemostatic and fibrinolytic systems.…”

Section: Vascular Surgerymentioning

confidence: 99%

“…However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. 36 Perioperative myocardial ischemia in noncardiac surgery is more frequent than venous thrombosis in the postoperative period of major vascular surgery and is associated with higher mortality. 37,38…”

Section: Vascular Surgerymentioning

confidence: 99%

Altered Fibrinolysis during and after Surgery

Méndez

Sabaté

2021

Semin Thromb Hemost

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Major surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces, a “physiologic” hemodilution of coagulation proteins, and an increase of plasmatic fibrinogen concentration and platelets. Increases in fibrinogen and platelets together with a simultaneous dilution of pro- and anticoagulant factors and development of a hypofibrinolytic status result in a postoperative hypercoagulable state. This profile is accentuated in more extensive surgery, but the balance can shift toward hemorrhagic tendency in specific types of surgeries, for example, in prolonged cardiopulmonary bypass or in patients with comorbidities, especially liver diseases, sepsis, and hematological disorders. Also, acquired coagulopathy can develop in patients with trauma, during obstetric complications, and during major surgery as a result of excessive blood loss and subsequent consumption of coagulation factors as well as hemodilution. In addition, an increasing number of patients receive anticoagulants and antiplatelet drugs preoperatively that might influence the response to surgical hemostasis. This review focuses on those situations that may change normal hemostasis and coagulation during surgery, producing both hyperfibrinolysis and hypofibrinolysis, such as overcorrection with coagulation factors, bleeding and hyperfibrinolysis that may occur with extracorporeal circulation and high aortic-portal-vena cava clamps, and hyperfibrinolysis related to severe maintained hemodynamic disturbances. We also evaluate the role of tranexamic acid for prophylaxis and treatment in different surgical settings, and finally the value of point-of-care testing in the operating room is commented with regard to investigation of fibrinolysis.

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“…There are, however, reasons to believe that a large proportion of these patients reflect non-ischemic cardiac injury in the form of perioperative stress cardiomyopathy, yet directed studies are needed to confirm this hypothesis. Perioperative disturbances in the hemostatic system may also play a role [ 72 ]. Resolving this issue is indeed of great importance, since MINS is associated with increased postoperative mortality [ 69 – 71 , 73 ], and accurate diagnosis is essential for proper treatment.…”

Section: Detriments Of Patient Stressmentioning

confidence: 99%

Patient periprocedural stress in cardiovascular medicine: friend or foe?

Iwaszczuk¹,

Łosiak²,

Szczeklik³

et al. 2021

pwki

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Stress, a disruption of homeostasis, is an unavoidable part of everyday life. In medical procedures, stress profoundly affects both operators and patients. Although the stress reaction has evolved to aid survival of physical trauma, it may also be harmful, by aggravating the baseline medical condition and/or creating new stress-related medical problems. Stress responses comprise several protective mechanisms that are particularly relevant in the clinical setting (e.g., a procoagulatory state and blood loss counteraction, preservation of blood perfusion pressure, prevention of hypoglycemia, enhanced immune response). Beneficial psychological effects prevent recurrence of traumatic memories, and promote patient compliance and positive lifestyle changes. In contrast, overt acute stress responses may lead to severe pathological conditions such as cytokine storm, post-traumatic stress disorder, takotsubo syndrome, deep venous thrombosis and pulmonary embolism, myocardial infarction, life-threatening arrhythmias and sudden cardiac death. There is also evidence that stress exposure may promote atherosclerosis and reduce long-term benefits from the intervention (increase in major adverse clinical events, in-stent restenosis, etc.). Insights into the role of stress on the operator's performance have recently led to the introduction of counteractive measures such as simulation training. Conversely, very little is known about the effect of the patient's periprocedural stress on the outcomes of cardiovascular procedures. Recent data show that the patient periprocedural stress affects the well-being of whole families. This review, focused on topics particularly relevant to cardiovascular interventions, provides a mechanistic insight into beneficial and harmful effects of periprocedural patient stress, including the array of available stress-relieving measures.

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Impact of Arterial Procedures on Coagulation and Fibrinolysis – A Pilot Study

Cited by 4 publications

References 34 publications

The Proinflammatory Soluble CD40 Ligand Is Associated with the Systemic Extent of Stable Atherosclerosis

The Proinflammatory Soluble CD40 Ligand Is Associated with the Systemic Extent of Stable Atherosclerosis

Altered Fibrinolysis during and after Surgery

Patient periprocedural stress in cardiovascular medicine: friend or foe?

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