title: Coagulation-Fibrinolysis System and Postoperative Outcomes of Patients With Chronic Thromboembolic Pulmonary Hypertension.
abstract: BACKGROUND
  The postoperative changes in the coagulation-fibrinolysis system and the association between the system and postoperative course of patients with chronic thromboembolic pulmonary hypertension (CTEPH) who have undergone pulmonary endarterectomy (PEA) remain unclear.
  
  
  RESULTS
  Between 1986 and 2013, 117 patients (55.1±11.2 years, preoperative mean pulmonary arterial pressure 46.5±10.5 mmHg) underwent PEA, and 15 patients died during the perioperative period. We studied the association between the preoperative coagulation-fibrinolysis markers and surgical outcomes of all patients, and the long-term outcomes of the 102 survivors from the date of PEA. We also investigated the postoperative changes in coagulation-fibrinolysis markers and their association with residual pulmonary hypertension (PH) in 20 consecutive patients. Only an elevated factor VIII level was associated with perioperative death. Thrombomodulin and plasminogen values were significantly increased after PEA. Univariate logistic regression analysis revealed that D-dimer positivity at follow-up was a risk factor for residual PH. Patients with both an elevated fibrinogen level (≥291 mg/dl [median]) and decreased plasminogen activity (<100% [median]) had significantly worse disease-specific survival than the other patients (5-year disease-specific survival: 84.0% vs. 100%, respectively; P=0.0041 [log-rank test]).
  
  
  CONCLUSIONS
  Preoperatively high fibrinogen and low plasminogen values in patients with CTEPH are associated with poor long-term postoperative outcome. PEA benefited not only the pulmonary hemodynamics but also the coagulation-fibrinolysis system of patients.
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kato
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanabe
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ishida
authors.forename: Rika
authors.initials: R
authors.lastname: Suda
authors.forename: Ayumi
authors.initials: A
authors.lastname: Sekine
authors.forename: Rintaro
authors.initials: R
authors.lastname: Nishimura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Jujo
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sugiura
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sakao
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tatsumi
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D018572:Disease-Free Survival; D004691:Endarterectomy / Q000009:adverse effects*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005342:Fibrinolysis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010958:Plasminogen / Q000378:metabolism*; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality; D011655:Pulmonary Embolism / Q000097:blood / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D005340:Fibrinogen; D010958:Plasminogen