Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery

Abstract

Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre-and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1,3, and 7. The following parameters were assessed: prothrombin fragment 1+2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-c~__-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P<0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P<0.01) and a decrease in tissue plasminogen activator and plasmin-%-antiplasmin complexes was also observed early

Pathogenesis of postoperative adhesion formation

“…Much less pronounced were the changes during cholecystectomy and thyroid resection ( Table 4). Similar results were reported by Diamantis et al 80 , who examined differences in activation of coagulation and fibrinolytic pathways between open and laparoscopic surgery, and by López and co-workers 77 , who studied postoperative differences between orthopaedic and abdominal surgery. Overall, in these studies surgery led to hypercoagulability, with open surgery leading to a stronger activation of the clotting system in plasma than laparoscopic procedures 77,79,80 .…”

“…Many surgeons assume that laparoscopy induces fewer adhesions than laparotomy owing to less peritoneal trauma. Previous studies showed that open surgery led to a significantly greater activation of the clotting system in plasma than laparoscopic procedures 77,78,80 . Adhesion formation, however, has not been evaluated properly as primary endpoint in prospective studies comparing laparoscopy and laparotomy.…”

“…Age 80,88 , diurnal variations 89 , sex and other genetic factors 90 , obesity 91 , medication 92 -95 , ongoing infection 82,94 , smoking and alcohol intake 96 , diabetes 97 , phase of the menstrual cycle 98 , hypercholesterolaemia 99 , benign versus malignant disease 100,101 , stress 90,102 and pregnancy 103 have all been found to influence one or more of the risk factors inflammation, coagulation and fibrinolysis. In addition, numerous surgical factors contribute to fibrin persistence, including type and duration of surgery 77,78,80 , use of irrigation, anaesthetic used 104 , additional medication (such as antibiotics) and blood transfusion 105 .…”

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

“…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. A difference in fibrinolytic response according to the type of surgery has been described when comparing orthopaedic and abdominal surgery [17]. In only concerned the intensity of decrease in fibrinolytic activity (which is more pronounced in orthopaedic surgery).…”

Cellular, hemostatic, and inflammatory parameters of the surgical stress response in pigs undergoing partial pericardectomy via open thoracotomy or thoracoscopy

“…It develops after surgery from activation of the hemostatic system and partial shutdown of the fibrinolytic system, and has been shown to correlate well with the extent of surgical trauma [19,28].…”