Impact of Arterial Procedures on Coagulation and Fibrinolysis - A Pilot Study

Abstract Objective: The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways. Methods: We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate &lt; 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure. Results: Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P&lt;0.001), antithrombin (92.1 vs. 74.8, P&lt;0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P&lt;0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21). Conclusion: Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.摘要 研究目的：本研究旨在评估血管手术（vascular procedures）对止血与纤溶通路（hemostatic and fibrinolytic pathways）活性的影响。 方法：本研究纳入38例年龄≥45岁的患者，均因腹主动脉瘤（abdominal aortic aneurysm）或外周动脉疾病（peripheral artery disease）接受手术，采用全身麻醉或区域麻醉（general or regional anesthesia），且术后至少住院一晚。排除接受颈动脉手术（carotid artery surgery）、术前3个月内发生静脉血栓栓塞症（venous thromboembolism）、旁路移植血管急性血栓形成（acute bypass graft thrombosis）、癌症、估算肾小球滤过率（estimated glomerular filtration rate）<30 ml/min/1.73m2定义的肾功能衰竭，以及合并急性感染的患者。分别于血管手术前及术后6~12小时，检测止血相关标志物[凝血因子Ⅷ（factor Ⅷ）、血管性血友病因子瑞斯托霉素辅因子（von Willebrand factor:ristocetin cofactor，vWF:CoR）、抗凝血酶（antithrombin）]、纤溶相关标志物[D-二聚体（D-dimer）、组织型纤溶酶原激活剂（tissue plasminogen activator，tPA）、纤溶酶-抗纤溶酶复合物（plasmin-antiplasmin complexes）]及可溶性CD40配体（soluble cluster of differentiation 40 ligand，sCD40L）的水平。 结果：术前与术后的凝血因子Ⅷ[（158.0 vs 103.3），P<0.001]、抗凝血酶[（92.1 vs 74.8），P<0.001]、D-二聚体[（938.0 vs 2406.0），P=0.005]、tPA[（10.1 vs 12.8），P=0.002]及sCD40L[（9092.9 vs 1249.6），P<0.001]水平均存在显著差异。而术前与术后的vWF:CoR[（140.6 vs 162.8），P=0.17]及纤溶酶-抗纤溶酶复合物[（749.6 vs 863.7），P=0.21]水平无显著差异。 结论：血管手术可导致止血与纤溶系统发生显著改变，但此类改变在两条通路中的具体方向尚未明确，且似乎因手术类型不同而存在差异。未来有必要开展更大样本量、采用动态凝血与纤溶评估方法（dynamic methods of coagulation and fibrinolysis assessment）的相关研究。