Changes of Hemostatic Molecular Markers After Gynecological Surgery

Abstract

The authors evaluated the hemostatic abnormalities occurring in the postoperative period of eight patients with malignant tumors and compared them with those occurring in the postoperative period of eight patients with benign tumors. Two of the patients with malignant tumor presented pulmonary embolism after operation. Plasma fibrinogen and fibrin degradation product levels in patients with malignant tumors were already high before operation and further increased significantly after operation. The plasma levels of D-dimer, thrombin-antithrombin complex, and free-tissue factor pathway inhibitor were increased in both groups after operation, but they were higher in patients with malignant tumors than in patients with benign tumors. The plasma levels of protein C and antithrombin were significantly decreased in both groups after operation. but they were significantly lower in patients with malignant tumors than in those with benign tumors. The decreased activity of protein C or antithrombin may be not only a risk factor of thrombotic disease, such as pulmonary embolism, but also the cause of thrombosis. In patients with malignant tumors, the operation time was significantly longer than that in patients with benign tumors. This long operative period might cause vascular endothelial cell injury which is reflected by the plasma levels of free-tissue factor pathway inhibitor, antithrombin, and protein C.

Impact of anaesthesia–surgery on D‐dimer concentration and end‐tidal CO2 and O2 in patients undergoing surgery associated with high risk for pulmonary embolism

“…The current mainstay of pulmonary vascular imaging for PE, computed tomography (CT) angiography, carries several risks to the postsurgical patient, including the indirect risk of patient transport, contrast allergy, contrast nephropathy, radiation exposure and economic cost when the CT angiography shows no treatable condition (Brenner et al, 2003;Hunold et al, 2003;Cochran, 2005;Josephson et al, 2005;Lin & Bonventre, 2005;Mitchell & Kline, 2007). Because of its high false-positive rate, the D-dimer has little utility as a screening tool in the immediate postsurgical period (Noda et al, 2000;Boncinelli et al, 2001;Arnesen et al, 2003;Karnani et al, 2005). Likewise, measurement of the arterial blood partial pressures of oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) seldom affects clinical decisionmaking in the evaluation of PE (Kline et al, 2000).…”

The Role of Hemostatic System Inhibitors in Malignancy

“…15,16 Surgery performed in gynecologic cancer patients leads to a more pronounced increase of free plasma TFPI and a greater decrease of plasma AT and protein C (PC) than in women undergoing surgical procedures due to benign disease. 17 More sophisticated procedures employed in oncologic patients are also associated with an increased risk for developing thromboembolic complications. For example, in patients undergoing bone marrow transplantation, decreased plasma concentrations of PC and AT, concurrent with an increased plasminogen activator inhibitor-1 (PAI-1) level, precede the occurrence of hepatic venoocclusive disease (VOD).…”