Relationship between postsurgical fibrinolytic parameters and deep vein thrombosis in surgical patients treated with compression devices.
This study consisted of 52 patients admitted for orthopedic surgery and 28 patients admitted for general surgery, who were treated with Sequential Compression Devices (SCD) and Thromboembolic Deterrent Stockings (TEDS) and monitored for the development of deep vein thrombosis (DVT). Coagulation and fibrinolytic profiles were carried out on these patients preoperatively, and on days one, three, and six postoperatively. All patients were followed by I-125-Fibrinogen scanning, Venous Doppler, and Impedance Plethysmography studies for clot detection. In the orthopedic surgery group, six (11.5%) developed DVT, and in the general surgery group, one (3.6%) developed DVT. No patients developed pulmonary embolism. The combined incidence of DVT was 8.8 per cent. A variety of parameters was measured in order to determine whether compression devices prevent a fibrinolytic shut-down commonly seen in the postsurgical patient. A combination of three assays was found to be significant in demonstrating a fibrinolytic response. These parameters were a post-surgical decrease in the plasminogen level, an increase in the level of free protease activity postoperatively, and an increase in the level of tissue plasminogen activator after surgery. 56.3 per cent of all patients treated with SCD and TEDS showed a fibrinolytic response on postoperative day one by a combination of all three of these parameters. In the group of patients that developed DVT none showed an increase in free protease activity, and five of seven showed no significant decrease in plasminogen and no increase in tissue plasminogen activator. Patients who developed thrombosis had measurable differences in their fibrinolytic system compared to those without postoperative thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Summaria
L
L
Department of Surgery, Evanston Hospital, Illinois 60201.
Caprini
J A
JA
McMillan
R
R
Sandesara
J
J
Axelrod
C A
CA
Mueller
M E
ME
Vagher
J P
JP
Walenga
J
J
Fareed
J
J
D003020:Clothing; D010450:Endopeptidases / Q000097:blood; D005260:Female; D005342:Fibrinolysis; D005676:Gravity Suits; D006801:Humans; D008297:Male; D010958:Plasminogen / Q000097:blood; D011183:Postoperative Complications / Q000503:physiopathology* / Q000517:prevention & control; D011184:Postoperative Period; D013927:Thrombosis / Q000503:physiopathology* / Q000517:prevention & control; D014018:Tissue Distribution
D010958:Plasminogen; D010450:Endopeptidases