title: Coagulation, fibrinolysis, and platelet activation in patients undergoing open and endovascular repair of abdominal aortic aneurysm.
abstract: BACKGROUND
  Endovascular aneurysm repair (EVAR) is associated with an improved perioperative mortality compared to open surgical repair. This benefit may reflect reduced incidence of microvascular and macrovascular thrombotic complications after EVAR.
  
  
  OBJECTIVE
  The purpose of this study was to review and compare the effects of abdominal aortic aneurysm (AAA), open surgical repair, and EVAR on coagulation, fibrinolysis, and platelet activation.
  
  
  METHODS
  A MEDLINE (1966-2010) and Cochrane library search for articles relating to the effects of AAA, open surgical repair, and EVAR on hemostasis was performed utilizing and cross-linking terms such as clotting, fibrinolysis, AAA, EVAR, and open surgical repair. Studies with a small cohort of patients (less than 7) or in which values of assessed biomarkers were not included were rejected.
  
  
  RESULTS
  AAA is associated with increased thrombin generation, activity, and fibrin turnover as evidenced by increased plasma levels of thrombin-antithrombin III-complex (TAT), activated protein C-protein C inhibitor (APC-PCI), fibrin-monomer-fibrinogen (FM-F), F1+2, fibrinogen, and D-dimer. The extent of hemostatic derangement correlates with the volume of intraluminal thrombus. This procoagulant state is exaggerated in the immediate perioperative period after both open surgical repair and EVAR, but is attenuated at medium-term follow-up although not normalized.
  
  
  CONCLUSIONS
  The resultant prothrombotic diathesis after open surgical repair and EVAR may account for the high level of perioperative thrombotic complications.
authors.affiliation: University Hospital Birmingham NHS Foundation Trust, Department of Vascular Surgery Heart of England NHS Foundation Trust, Netherwood House, Birmingham B91 2JL, United Kingdom. rsmdavies@mac.com
authors.forename: Robert S M
authors.initials: RS
authors.lastname: Davies
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelhamid
authors.forename: Michael L
authors.initials: ML
authors.lastname: Wall
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Vohra
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bradbury
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Adam
mesh_terms: D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D015539:Platelet Activation; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers