Blood coagulation and fibrinolytic response after endovascular stent grafting of thoracic aorta.
OBJECTIVE
Thrombosis is common in aneurysms immediately after stent-grafting, because of exclusion from systemic blood flow. We studied changes in blood coagulation and the fibrinolytic system in patients with thoracic aortic aneurysm or dissection after stent-grafting to examine risk for consumption coagulopathy.


METHODS
Thirty-one thoracic aortic aneurysms were treated with stent-grafting (aneurysm group), and 29 aortic dissections were treated with entry closure with stent-grafting (dissection group). The stent-graft was constructed from a self-expanding Z stent and thin-walled woven polyester fabric. Platelet count, fibrinogen, antithrombin III (AT III), and thrombin-AT III complex were assayed as markers of coagulation. Plasminogen, alpha(2)-plasmin inhibitor, alpha(2)-plasmin inhibitor-plasmin complex, fibrin degradation products fragment E (FDP-E), and fibrin degradation products d-dimer were monitored as markers of fibrinolysis. Blood samples were collected before surgery and on postoperative days 1, 3, 7, and 14.


RESULTS
In both groups platelet count significantly decreased on postoperative days 1 and 3, and increased on postoperative day 14. AT III significantly decreased on postoperative day 1, but recovered after postoperative day 7. FDP-E significantly increased on postoperative day 1 in both groups. There was significant correlation of aneurysm diameter with alpha(2)-plasmin inhibitor-plasmin complex, fibrin degradation products, and d-dimer in the dissection group on postoperative day 1.


CONCLUSIONS
Activation of coagulation and fibrinolysis was observed after stent-grafting to treat thoracic aortic aneurysm and aortic dissection. However, no patients exhibited consumption coagulopathy postoperatively. Therefore we believe there is little risk for consumption coagulopathy after stent-grafting.
Shimazaki
Taro
T
Department of Surgery II, Tokyo Medical University, Tokyo, Japan. taro-shi@pa2.so-net.jp
Ishimaru
Shin
S
Kawaguchi
Satoshi
S
Yokoi
Yoshihiko
Y
Watanabe
Yoshiko
Y
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000503:physiopathology* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology* / Q000601:surgery*; D001777:Blood Coagulation / Q000502:physiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*