title: Association between early postoperative coagulation activation and peri-operative myocardial ischaemia in patients undergoing vascular surgery.
abstract: We investigated the association of peri-operative myocardial ischaemia with activation of coagulation and endogenous fibrinolysis in patients undergoing vascular surgery. In 50 patients, continuous Holter monitoring was performed to assess peri-operative myocardial ischaemia and 12-lead electrocardiography was recorded preoperatively and 72 h postoperatively to assess myocardial infarction. Serial blood samples were drawn peri-operatively to determine the concentrations of fibrin monomers (for activation of coagulation), D-dimer (for endogenous fibrinolysis) and cardiac troponin T and I. Patients with myocardial ischaemia showed higher concentrations of fibrin monomers at 48 h, and higher concentrations of d-dimer preoperatively and at 24 and 48 h postoperatively. In patients with peri-operative myocardial ischaemia, strong positive correlations were observed between fibrin monomer and D-dimer concentrations at 15 min and 4 h postoperatively, and cardiac troponins at 15 min and at 4, 24, 48 and 72 h postoperatively. Early postoperative activation of coagulation and fibrinolysis is associated with peri-operative myocardial cell damage among patients who are at risk for, or have a history of, coronary artery disease plus peri-operative myocardial ischaemia.
authors.affiliation: Department of Anaesthesiology, University of Heidelberg, Germany.
authors.forename: B W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: S A
authors.initials: SA
authors.lastname: Snyder-Ramos
authors.forename: W
authors.initials: W
authors.lastname: Lapp
authors.forename: J
authors.initials: J
authors.lastname: Motsch
authors.forename: M
authors.initials: M
authors.lastname: Aulmann
authors.forename: M
authors.initials: M
authors.lastname: Schweizer
authors.forename: E L
authors.initials: EL
authors.lastname: Layug
authors.forename: E
authors.initials: E
authors.lastname: Martin
authors.forename: D T
authors.initials: DT
authors.lastname: Mangano
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D015716:Electrocardiography, Ambulatory; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D017202:Myocardial Ischemia / Q000097:blood* / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood; D011184:Postoperative Period; D012307:Risk Factors; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D019210:Troponin I; D020107:Troponin T; C036309:fibrin fragment D; C011468:fibrinmonomer