Ischaemia and reperfusion during open abdominal aortic aneurysm surgery induce extensive thrombin generation and activity.
OBJECTIVE
does open surgery for abdominal aortic aneurysm (AAA) influence coagulation?


METHODS
in 23 patients operated on for AAA, cubital blood was sampled pre-, intra- and postoperatively. Femoral blood was also sampled intraoperatively.


RESULTS
preoperatively, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and soluble fibrin (SF) were elevated in AAA patients. During aortic clamping all parameters increased significantly in cubital blood (p<0.01) as well as in femoral blood (p<0.001) and after aortic declamping F1+2 and TAT increased further. F1+2, TAT and SF were significantly higher in femoral than cubital blood. Postoperatively F1+2 and TAT returned to preoperative values, while SF still had a significantly higher level than preoperatively (p<0.001). Blood loss showed co-variation with F1+2 increase in femoral blood after aortic declamping (p<0.05).


CONCLUSIONS
these data indicate that the coagulation system was strongly activated by the occurrence of an AAA. During AAA surgery a further extensive activation was seen. The activity was still high, but on decline, one week postoperatively. Ischaemia and reperfusion of the lower part of the body were the major stimuli for thrombin generation and activity.
Holmberg
A
A
Department of Surgery, Unit of Coagulation Disorders and Clinical Chemistry, Uppsala, S-751 85, Sweden.
Siegbahn
A
A
Westman
B
B
Bergqvist
D
D
D000328:Adult; D000368:Aged; D000991:Antithrombins / Q000032:analysis; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005337:Fibrin / Q000032:analysis; D006801:Humans; D007511:Ischemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D011498:Protein Precursors / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D015424:Reperfusion; D013917:Thrombin / Q000032:analysis*
D000991:Antithrombins; D010446:Peptide Fragments; D011498:Protein Precursors; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D011516:Prothrombin; D005337:Fibrin; D013917:Thrombin