Perioperative prophylaxis with a low molecular weight heparin reduces late PAI-1 levels after gynaecological surgery

Legnani, Cristina; Maccaferri, M.; Palareti, Gualtiero; Ludovici, S.; Guazzaloca, Giuliana; Marabini, A; Orlandi, C; Coccheri, S.

doi:10.1016/0268-9499(90)90022-c

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…This, in turn would be consistent with the lower increase in PAI-1 levels after gynaecological surgery that has been found in patients treated with LMW heparin in comparison with unfractionated heparin [14].…”

Section: Discussionsupporting

confidence: 74%

“…Moreover, LMW heparins can have a greater profibrinolytic effect than standard heparin [14]. In a previous study [6] we observed that unfractionated heparin treatment significant ly decreases PCI levels, but the effect of LMW heparin on PCI levels has not been reported.…”

Section: Introductionmentioning

confidence: 92%

“…The risk of venous thrombo-embolism during gynaecological surgery in patients without anticoagulant prophylaxis is reported to range from 7 to 45% [11,12], This high incidence of postoperative DVT can be re duced by heparin prophylaxis [13,14], Low molecular weight (LMW) heparins have been used as prophylactic drugs in gynaecological postoperative thrombosis, and have had a more selective antithrombotic action and fewer haemorrhagic side effects [13,14]. Moreover, LMW heparins can have a greater profibrinolytic effect than standard heparin [14].…”

Section: Introductionmentioning

confidence: 99%

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Alterations in Fibrinolytic and Protein C Pathways in Gynaecological Surgery: Low Molecular Weight Heparin Prophylaxis

Estellés¹,

Gilabert

España³

et al. 1994

Pathophysiol Haemos Thromb

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Several parameters of fibrinolytic and protein C pathways were evaluated in three groups of patients with high (HR), moderate (MR) and low (LR) postoperative thrombotic risk undergoing major gynaecological surgery. The HR and MR groups were subjected to low molecular weight heparin (LMW) prophylaxis. A significant increase in plasminogen activator inhibitor type 1 (PAI-1) antigen and activity levels was observed in the HR patient group in comparison with the MR and LR groups in the preoperative and early postoperative period. In all the groups studied, the maximum increase in the levels of PAI-1 was seen on day 1 after surgery. However, the D-dimeric levels reached the highest level on day 7. A significant increase in activated protein C:α₁antitrypsin (APC:α1AT) complex levels was observed in the HR group in comparison with the LR group, and a strong decrease in protein C inhibitor in the early postoperative period was detected in all the groups. In spite of heparin prophylaxis, 2 HR patients were diagnosed as deep vein thrombosis (DVT) during the postoperative period. Both patients showed pre-operative levels of PAI-1 antigen or activity and APC:α₁AT complexes above the mean + 1 SD of the pre-operative levels in the HR group. In conclusion, in HR patients a hypofibrinolytic and hypercoagulable state was detected in the pre-operative and early postoperative periods. The prophylactic LMW heparin dose used in the present report (20 mg/day × 7) was insufficient to prevent DVT in the HR group. At present our HR patients are given higher doses of LMW heparin (40 mg/day × 7).

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 92%