title: Plasma thrombin-antithrombin complex, prothrombin fragments 1 and 2, and D-dimer levels are elevated after endovascular but not open repair of infrarenal abdominal aortic aneurysm.
abstract: BACKGROUND
  Abdominal aortic aneurysm (AAA) is associated with hypercoagulability, evidenced by increased markers of coagulation activation, including thrombin-antithrombin complex (TAT), prothrombin fragments 1 and 2 (F1+2), and D-dimer. Our aim was to compare the effect of endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) on changes in coagulation activation markers after intervention.
  
  
  METHODS
  Consecutive patients with AAAs reaching their intervention threshold in a tertiary vascular referral unit in the United Kingdom were invited to participate. The coagulation markers TAT, F1+2, and D-dimer were measured in venous blood collected at baseline and at 5 months after intervention. A forward stepwise multiple linear regression model was used to identify whether treatment by OAR or EVAR had an effect on changes in coagulation factors, independent of significant covariates.
  
  
  RESULTS
  The study included 47 patients (14 EVAR, 33 OAR; 85% men) who were a median age of 76 years (range, 69.5-80 years). Aortic diameter at intervention was 5.9 cm (range, 5.5-6.8 cm). There were no significant differences in clinical, anthropometric, or hematologic parameters between groups. At baseline, TAT (P = .13), F1+2 (P = .08), and D-dimer (P = .11) were similar in EVAR and OAR patients. Postintervention, there was a significant increase in TAT (3.0 [2.1-6.0] vs 7.2 [6.3-8.4] ng/mL; P = .03), F1+2 (242 [189-323] vs 392 [312-494] ng/mL; P = .003), and D-dimer (457 [336-615] vs 1197 [840-1509] ng/mL; P = .002) in the EVAR group. No significant changes were observed after intervention in the OAR group.
  
  
  CONCLUSIONS
  AAA-related hypercoagulability persists after intervention, with increased TAT, F1+2, and D-dimer levels after EVAR. These findings suggest a potential period of increased cardiovascular risk in the postoperative period after EVAR.
authors.affiliation: Division of Cardiovascular & Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, Multi-Disciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, United Kingdom.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bailey
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Griffin
authors.forename: Soroush
authors.initials: S
authors.lastname: Sohrabi
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Whalley
authors.forename: Anne B
authors.initials: AB
authors.lastname: Johnson
authors.forename: Paul D
authors.initials: PD
authors.lastname: Baxter
authors.forename: Robert A S
authors.initials: RA
authors.lastname: Ariëns
authors.forename: D Julian A
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III; D017544:Aortic Aneurysm, Abdominal / Q000097:blood* / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000097:blood*; D010447:Peptide Hydrolases / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D011498:Protein Precursors; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D000990:Antithrombin III; D011516:Prothrombin; D010447:Peptide Hydrolases