title: Extrinsic pathway inhibitor in elective surgery: a comparison with other coagulation inhibitors.
abstract: Extrinsic coagulation pathway inhibitor may be an important regulator of haemostasis to prevent thrombosis after tissue damage. The functional activity of this inhibitor was determined using a chromogenic substrate assay, and compared to the activities of antithrombin, heparin cofactor II and protein C during the perioperative period of elective hip replacement (n = 28), cholecystectomy (n = 11), and vascular surgery (n = 5). Peroperatively, all the inhibitors decreased rather similarly and to the same degree as the decrease in albumin concentration. The decreases during hip surgery were about 2-fold the decreases observed during cholecystectomy. A significant peroperative increase in extrinsic pathway inhibitor activity was observed in vascular surgery, probably due to a bolus injection of heparin. Antithrombin, heparin cofactor II and protein C levels normalized on days 3-5 postoperatively in all three patient groups. Sustained low levels of extrinsic pathway inhibitor were observed on postoperative days 1 to 7 in hip surgery patients. Apparently, extrinsic pathway inhibitor is not an acute phase reactant. In uncomplicated surgery, the decreases of the coagulation inhibitor levels are mainly due to hemodilution.
authors.affiliation: Medical Department, Aker Hospital, University of Oslo, Norway.
authors.forename: P M
authors.initials: PM
authors.lastname: Sandset
authors.forename: H E
authors.initials: HE
authors.lastname: Høgevold
authors.forename: T
authors.initials: T
authors.lastname: Lyberg
authors.forename: T R
authors.initials: TR
authors.lastname: Andersson
authors.forename: U
authors.initials: U
authors.lastname: Abildgaard
mesh_terms: D000328:Adult; D000368:Aged; D005167:Factor VII / Q000032:analysis* / Q000037:antagonists & inhibitors; D005260:Female; D006400:Hematocrit; D015844:Heparin Cofactor II / Q000032:analysis; D006615:Hip / Q000601:surgery; D006801:Humans; D008074:Lipoproteins / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011480:Protease Inhibitors / Q000032:analysis*; D011486:Protein C / Q000032:analysis; D012709:Serum Albumin / Q000032:analysis; D013925:Thromboplastin / Q000032:analysis* / Q000037:antagonists & inhibitors; D013927:Thrombosis / Q000209:etiology
chemical_list: D008074:Lipoproteins; D011480:Protease Inhibitors; D011486:Protein C; D012709:Serum Albumin; C051928:lipoprotein-associated coagulation inhibitor; D015844:Heparin Cofactor II; D005167:Factor VII; D013925:Thromboplastin