Hypercoagulable abnormalities and postoperative failure of arterial reconstruction.
OBJECTIVE
To determine whether preoperative hypercoagulable abnormalities are independent risk-factors for the failure of arterial reconstruction in leg ischaemia.


METHODS
Sixty consecutive patients were studied before, and for 1 year following, elective peripheral revascularisation. Antithrombin III, protein C and protein S levels, and tests for lupus anticoagulant were performed preoperatively, and then repeated on the first and third postoperative days and after 1 and 6 months. Heparin-associated thrombocytopenia was also investigated if there was a postoperative fall in platelet count greater than 100 x 10(9)/l.


RESULTS
Forty-six (77%) procedures were performed for critical ischaemia and 15 (25%) involved infrapopliteal reconstruction. The nature of surgery or accepted risk factors for occlusion were comparable between the 40 (67%) patients with patent reconstructions at 1 year and the 20 (33%) who had suffered failure. Preoperative hypercoagulable abnormalities were detected in 21 (35%) patients, with a three times greater incidence in those whose reconstructions failed (65% vs. 20%, p < 0.01), and in 11 of 12 patients suffering early (within 1 month) occlusion. The lupus anticoagulant was more frequently detected when prosthetic grafts were already present (p < 0.05) and carried a positive predictive value for reocclusion of 67% (p < 0.01). All three postoperative deaths occurred in patients with low protein S levels before surgery.


CONCLUSIONS
Hypercoagulable abnormalities are common prior to arterial revascularisation and are independently associated with subsequent failure.
Ray
S A
SA
Department of Vascular Surgery, St. George's Hospital Medical School, London, U.K.
Rowley
M R
MR
Bevan
D H
DH
Taylor
R S
RS
Dormandy
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000378:metabolism; D001157:Arterial Occlusive Diseases / Q000097:blood* / Q000150:complications* / Q000209:etiology / Q000601:surgery; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000150:complications*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000209:etiology / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000378:metabolism; D012307:Risk Factors; D017211:Treatment Failure
D016682:Lupus Coagulation Inhibitor; D011486:Protein C; D017293:Protein S; D000990:Antithrombin III