Intra-Operative Activation of Coagulation - A Stimulus to Thrombosis Mediated by Vasopressin?

Abstract

SummaryVasopressin infusions in normal volunteers that produce concentrations in plasma comparable to those seen during stress, cause an increase in plasma factor VIII and shortening of the euglobulin clot lysis time (ECLT). We have investigated the relationship between endogenous vasopressin (aVP) release and haemostatic function in 7 patients undergoing major abdominal surgery. Blood samples were taken at nine intervals during the operative procedure. Plasma aVP levels peaked at median values of 51 pg/ml during bowel manipulation and remained elevated on the first post-operative day. Following, and in close temporal relationship with the rise in aVP there were increases in factor VIII coagulant activity, the ristocetin co-factor, von Willebrand antigen, plasminogen activator activity (106/ECLT2) and fibrinopeptide A concentrations with shortening of the activated partial thromboplastin time. The relationship was similar to that seen following infusion of a VP in human volunteers. The results are consistent with the hypothesis that aVP is an important mediator of changes in haemostatic function which accompany stress and might contribute to the thrombotic risk associated with surgical operations.

Myocardial infarction non‐invasively induced in rabbits by administering isoproterenol and vasopressin: protective effects exerted by verapamil†

“…Furthermore, as vasopressin alone or with isoproterenol lowers the plasma levels of NO, which is known to affect platelet aggregation [59], and both isoproterenol and vasopressin shorten PTT (as reported here and by others [21][22][23]), the association of both drugs seems to favour coagulation and may aggravate ischemic myocardial damage by eliciting thrombotic events.…”

Thrombotic risk factors associated with transurethral prostatectomy

“…There was a marked increase in both mean intraoperative lation values over the perioperative period [23,24]. The presence of a hypercoagulable state after TURP, serum PSA and serum PAP (Wilcoxon matched-pairs test, both P<0.001) levels compared with the mean as shown in the present study, is not surprising when compared with other surgical procedures [25]. However, preoperative values (Table 1).…”

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

“…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. A difference in fibrinolytic response according to the type of surgery has been described when comparing orthopaedic and abdominal surgery [17].…”