Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery.
OBJECTIVE
To evaluate the relationship between perioperative ischemia and serial concentrations of D-dimer, which is a sensitive and specific marker of fibrinolytic activity. Myocardial ischemia and infarction are well-recognized complications of peripheral vascular surgery. We hypothesized that patients at increased risk of perioperative myocardial ischemia might be identified preoperatively by abnormal hemostatic indices.


METHODS
Prospective clinical outcomes study.


METHODS
A 1,124-bed tertiary care medical center.


METHODS
42 ASA physical status II, III, and IV patients undergoing peripheral vascular surgery.


METHODS
Serial D-dimer concentrations were measured preoperatively, and at 24 and 72 hours postoperatively. Continuous 12-lead ST-segment monitoring (Mortara Instrument, Inc., Milwaukee, WI) was performed with the acquisition of a 12-lead ECG every 20 seconds for 72 hours.


RESULTS
D-dimer measurements were performed in duplicate using the Dimer Gold assay (American Diagnostica, Greenwich CT). Ischemic episodes, as defined by continuous 12-lead ST-segment monitoring, occurred in 49% of patients. There were no demographic differences between ischemic and nonischemic groups. Although baseline D-dimer concentrations were not statistically significantly different between groups, patients experiencing perioperative myocardial ischemia generated significantly less D-dimer during the perioperative period (p = 0. 014).


CONCLUSIONS
PATIENTS with an impaired fibrinolytic response, as defined by reduced generation of D-dimer, experienced an increased incidence of perioperative myocardial ischemia.
Lubarsky
D A
DA
Department of Anesthesiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. lubar001@mc.duke.edu
Fisher
S D
SD
Slaughter
T F
TF
Green
C L
CL
Lineberger
C K
CK
Astles
J R
JR
Greenberg
C S
CS
Inge
W W
WW
Krucoff
M W
MW
D000368:Aged; D000933:Antifibrinolytic Agents / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005342:Fibrinolysis / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000933:Antifibrinolytic Agents; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D