Fibrinolytic and Hemorheologic Alterations During and After Elective Aortic Graft Surgery

Abstract

The hemorheologic and fibrinolytic variables of 15 patients undergoing elective aortic graft surgery were investigated before, during, and after surgery. During the operation, a relative hemodilution was induced intentionally by an infusion of crystalloids and albumin. This led to a decrease in hematocrit (35.5 +/- 6.3-->31.8 +/- 5.6%, P < 0.01), fibrinogen, and platelets, as well as a decrease in fibrinolysis (Euglobulin Clot Lysis Time increases 246 +/- 52-->300 +/- 46 min and fast-acting plasminogen activator inhibitor 1 [PAI-1] activity increases 10.5 +/- 6.9-->15.1 +/- 9 IU/mL, P < 0.01). There was also specific rheologic impairment with a dissociation of erythro-aggregates (primary aggregation time 3.37 +/- 2.63-->7.18 +/- 7.2 s). Tissue-type plasminogen activator (t-PA) antigen was only increased just after surgery (8.3-->14.5 ng/mL, P < 0.01). During the first postoperative week, the acute-phase response subsided. This was accompanied by an increase in fibrinogen, von Willebrand factor antigen, and plasma viscosity (1.33 +/- 0.13-->1.49 +/- 0.13 mPa x s, P < 0.01). Hematocrit and the extrinsic fibrinolytic system (t-PA/PAI) returned to baseline values, whereas intrinsic fibrinolysis remained altered (the Euglobulin Clot Lysis Time, reflecting total activity of plasminogen activators, was still increased). Postoperative management may benefit from a recognition of these two distinct phases induced by surgery. The acute-phase reaction of the first postoperative week is an added vascular risk factor and requires a specific therapeutic approach.

Fibrinolytic and coagulation pathways after laparoscopic and open surgery: a prospective randomized trial

“…Most studies evaluating the perioperative alterations of hemostasis concern open surgery [7][8][9][10][11]. The risk of developing deep venous thrombosis after open surgery can be as high as 40-80%, while the incidence of fatal pulmonary embolism is 1-5% [1,12].…”

“…During clot formation, it is converted to fibrin via the enzymatic action of thrombin [21]. Low levels may indicate increased consumption (fibrinolysis), and increased levels, which are often noted after inflammation, reflect the close association between stress and coagulation activation [11]. In our study, the significant decrease of FIB plasma levels noted in the laparoscopy group immediately after surgery as compared with the minor insignificant decrease noted at the same time in the open surgery group is attributed to early activation of fibrinolysis in the laparoscopy group.…”

Changes in Haemostasis after Laparoscopic Surgery in Gynaecology: Contribution of the Thrombin Generation Test

“…There appears a discrepancy in the course of fibrinolysis after laparoscopic and after open surgery [11]. Indeed, in the literature, fibrinolysis activity is usually described to decrease during and immediately after open surgery due to an increase in PAI-1 activity [12,13]. This surgery-induced 'shut down' of fibrinolytic activity is thought to be related to a peroperative release of platelet PAI-1 [14], high levels of the pituitary hormone arginine vasopressin [15] and of inflammatory cytokines [16] in response to the surgical stress which induces a release of the endothelial protein PAI-1.…”

Mild Hyperhomocysteinemia and Hemostatic Factors in Patients with Arterial Vascular Diseases

“…In premature coronary arterial disease, PAI-1 has also been demonstrated to be increased and to present a strong association with lipids (especially triglyceride-rich lipoproteins), fibrinogen and activation of factor VII, all factors being related to each other and representing a "cluster" of risk factors (reviewed in 23). Although less studied, factors VIIIc and von Willebrand are also often increased in thrombosis risk situations, like the post-operative period (24). Von Willebrand factor has been claimed to be a factor for the development of thrombosis and atherosclerosis (25).…”