The relationship between plasma vasopressin and changes in coagulation and fibrinolysis during hip surgery.
To investigate whether vasopressin (aVP) could have a role in the regulation of coagulation and fibrinolysis during hip surgery, venous blood samples were taken for assay of FVIII:C, FVIII R:Co, vWF:Ag, fibrinopeptide A (FPA), euglobulin clot lysis time (ECLT), high molecular weight fibrin breakdown products (XL-FDP) platelet aggregation in whole blood and aVP from seven patients undergoing elective hip surgery. Samples were taken at set points over the operative period. FVIII:C increased during the operation from a geometric mean of 0.7 iU/ml pre-operatively to 1.09 iU/ml (p less than 0.05) post-operatively. vWF:Ag and FVIII R:Co rose in a similar manner. PAA (10(6)/ECLT2) rose from 12 units pre-operatively to 167 units (p less than 0.001) at prosthesis cementing, and post-operatively fell to subnormal levels. FPA increased from 13 pmol/ml to 58 pmol/ml (p less than 0.05) at prosthesis cementing, and fell to 9 pmol/ml post-operatively. Plasma XL-FDP rose from 115 ng/ml pre-operatively to 456 ng/ml at skin closure (p less than 0.05). Plasma aVP rose from 0.5 pg/ml pre-operatively to 40 pg/ml (p less than 0.01) at division of the femoral neck. There were no changes in platelet aggregation using 1.5 microM ADP. The results demonstrate activation of coagulation and fibrinolysis during the operative procedure. The mechanisms involved in these changes are complex, but the results support the hypothesis that aVP has effects on factor VIII and fibrinolysis similar to those described for abdominal surgery.
D001127:Arginine Vasopressin / Q000097:blood*; D001777:Blood Coagulation; D005169:Factor VIII / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D005344:Fibrinopeptide A / Q000378:metabolism; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D013924:Thrombophlebitis / Q000209:etiology; D014841:von Willebrand Factor / Q000378:metabolism
D005338:Fibrin Fibrinogen Degradation Products; D014841:von Willebrand Factor; D001127:Arginine Vasopressin; D005344:Fibrinopeptide A; D005169:Factor VIII