Changes in Blood Coagulation and Fibrinolysis during the Postoperative Period
TL;DR: It was concluded that a particular determination of a parameter in a case of suspected thrombosis is probably not reliable as a diagnostic aid for suspected thROMbosis because of the great difference in magnitude and duration of the changes in the individual parameters studied.
Abstract: The reaction pattern of different parameters in blood coagulation and fibrinolysis was studied during the postoperative period. A series of twenty-four patients undergoing various operations is presented. One of these patients suffered a clinically evident venous thrombosis during the postoperative period. When the postoperative period was uncomplicated, generally the same course of changes were observed in all patients, these changes differing from case to case only in magnitude and duration. In the first days post-operatively, there was a decrease in the number of platelets and a rapid increase in the fibrinogen concentration and in the factor VIII activity. During the same period there was a decrease in both plasminogen concentration and spontaneous fibrinolytic activity. In most cases, increased antifibrinolytic activity was observed. Subsequently in the postoperative period, the number of platelets increased and there was a gradual return to normal of the fibrinogen concentration and the factor VIII activity. During this period the plasminogen concentration increased above the preoperative value and the spontaneous fibrinolytic activity gradually returned to normal. However, when the postoperative period was complicated by, for example, a venous thrombosis, the reaction pattern changed. It was concluded that because of the great difference in magnitude and duration of the changes in the individual parameters studied, a particular determination of a parameter in a case of suspected thrombosis is probably not reliable as a diagnostic aid for suspected thrombosis. A continuous control of appropriate tests after the operation may, however, disclose if a thromboembolic complication is present, because when such complications occur, the normal reaction pattern of the different parameters is considerably changed.
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TL;DR: Clinically important bleeding was not increased in heparin-treated surgical patients, though the blood requirement of transfused thromboplastin time was moderately increased for five hours after subcutaneous Heparin injections.
Abstract: The effect of 5000 U of heparin given subcutaneously three times daily on the frequency of venous thrombosis detected by 125-I-fibrinogen scanning was evaluated in a prospective randomized study of 350 high-risk surgical and medical patients. Heparin treatment reduced the rate of venous thrombosis from 19 of 118 patients (16.1 per cent) to two of 108 (1.9 per cent) treated after elective surgery, from 11 of 23 untreated (48 per cent) to three of 23 (13 per cent) treated after hip fracture, and from nine of 40 (22.5 per cent) to one of 38 (2.6 per cent) treated patients admitted to the hospital for suspected myocardial infarction. Thrombosis occurred in 21.5 per cent of the total of 181 untreated and in 3.6 per cent of 169 heparin-treated patients. The activated partial thromboplastin time was moderately increased for five hours after subcutaneous heparin injections. Clinically important bleeding was not increased in heparin-treated surgical patients, though the blood requirement of transfused pat...
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TL;DR: The effect of short-term stress on blood clotting times, cell counts, haematocrits, and blood glucose levels was studied in a hatchery strain and wild type rainbow trout, Salmo gairdneri.
Abstract: The effect of short-term stress on blood clotting times, cell counts, haematocrits, and blood glucose levels was studied in a hatchery strain and wild type rainbow trout, Salmo gairdneri. Blood clotting times declined and thrombocyte counts, haematocrits, and blood glucose levels increased after stress in both strains of trout. The wild type of rainbow trout, however, required less time to recover from the stress than the hatchery strain of rainbow trout. The implications of a stress activated blood coagulation system in fish are discussed.
183 citations
TL;DR: Risk factors and mechanisms of ischemic strokes after general surgery most commonly occur after an asymptomatic interval, and previous cerebrovascular disease, COPD, and PVD greatly increase the risk.
Abstract: Objective: To describe risk factors and explore mechanisms of ischemic strokes after general surgery. Background: Strokes follow general surgery in about 0.08% to 2.9% of cases. Patients with previous cerebrovascular disease, atrial fibrillation, hypertension, advanced age, or atherosclerosis were found to have an increased risk. Knowledge of factors involved may guide physicians in determining the overall risk of surgery. Methods: This case-control study was performed in a referral center. A total of 61 patients identified through a computerized database with ischemic strokes after surgical procedures-excluding heart, brain, vessels, or neck-between July 1986 and July 1996 were studied. Procedures included 11 urogenital, 16 gastrointestinal, 17 orthopedic, 12 pulmonary, and 5 other. A total of 122 randomly selected controls were matched for age, sex, procedure, and year of procedure. Main outcome measures included arterial territory, timing, risk factors, and perioperative events. Differences were expressed as adjusted odds ratios (AOR) with 95% confidence limits (CL), using multivariate conditional logistic analyses for matched case-control design. Results: Arterial territory included 37 middle cerebral artery, 11 posterior circulation, 7 borderzone, and 6 multiple. Median procedure to stroke interval was 2 days (range, 0 to 16); 10 patients had intraoperative strokes. Three major risk factors emerged: previous cerebrovascular disease(AOR 12.57, 95% CL 2.14/73.70), chronic obstructive pulmonary disease (COPD)(7.51, 1.87/30.12), and peripheral vascular disease (PVD) (5.35, 1.25/22.94). After adding stroke-related factors, PVD (14.70, 2.01/107.71) and COPD(10.04, 1.90/53.14) remained the strongest variables; blood pressure(1.05, 1.01/1.10) and urea (1.04, 1.01/1.07) contributed slightly. Hypotension did not contribute. Four patients (6.6%) and no controls had diffuse intravascular coagulation ( p = 0.01). Four stroke patients had myocardial infarction (6.6% versus 0%; p = 0.01). Conclusions: Ischemic strokes after general surgery most commonly occur after an asymptomatic interval. Previous cerebrovascular disease, COPD, and PVD greatly increase the risk. Hypotension rarely accounts for postoperative strokes. Major comorbidity of the patient at risk seems more important than complicating events during surgery.
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References
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TL;DR: In this paper, the control of Dicumarol therapy and the Quantitative Determination of Prothrombin and Proconvertin were discussed, and the authors proposed a method for the quantification of ProConvertin and Thrombin.
Abstract: (1951). The Control of Dicumarol Therapy and the Quantitative Determination of Prothrombin and Proconvertin. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 3, No. 3, pp. 201-208.
653 citations
194 citations
TL;DR: Serial changes in coagulation and fibrinolysis studied among 42 patients admitted to hospital with a wide variety of injuries are reported, including thrombosis in vivo, and reference is made to homeostatic significance and its possible breakdown.
Abstract: Serial changes in coagulation and fibrinolysis studied among 42 patients admitted to hospital with a wide variety of injuries are reported. The first hours after trauma are dominated by an acceleration of fibrinolysis (clot lysis) and clotting time which are often followed by an abrupt rebound to prolonged fibrinolysis and normal clotting. Evidence is presented that acceleration of fibrinolysis is due to flooding of the circulation by plasminogen activator and that prolongation is probably due to an inhibitor. A prolonged prothrombin time, increased prothrombin consumption index, an acceleration of the heparin-retarded clotting time, and a fall in the platelet count are also frequent during the first hours after injury. There is evidence also of an early deficiency in factor V and the onset of a fall in factor VII and prothrombin. The following days are characterized by continued prolongation of fibrinolysis, a lengthening of clotting time, and an increased prothrombin consumption index suggestive of a defect in thrombo-plastin generation. Subsequent periods of prolonged fibrinolysis may develop. Prothrombin time often continues prolonged for one to three weeks and may vary phasically; plasma prothrombin and factor VII are reduced but there is now little change in factor V. The platelet count continues to fall for one to three days, then a thrombocytosis develops, often with abnormally high platelet levels, a week or so later. Plasma fibrinogen rises within 24 hours to reach a plateau maximum a few days later and levels remain high for prolonged periods in the severely injured. Various changes are related to or influenced by the severity of trauma. Mechanisms are discussed, including thrombosis in vivo, and reference is made to homeostatic significance and its possible breakdown.
170 citations
TL;DR: In this article, the use of measures to increase venous return in patients who are immobilized in bed, plus the institution of prophylactic anticoagulant therapy in a selected group of patients with a high predisposition to the development of thromboembolic diseases, should result in a significant reduction in disability and mortality from this theoretically preventable disease.
Abstract: The manifestations of thromboembolism are highly variable and frequently obscure. Clinical diagnosis of these entities is difficult, and the majority of cases will not be diagnosed by the means presently available to us. Nevertheless, a heightened awareness of the vagaries of this disease can result in considerable improvement in diagnostic accuracy. Prompt diagnosis on the basis of the slightest clinical suspicion, followed by immediate and adequate anticoagulant therapy, should result in a measureable decrease in thromboembolic complications. However, if one hopes to achieve a profound reduction in incidence of thromboembolism, the only approach presently available is prophylactic rather than therapeutic. The use of measures to increase venous return in patients who are immobilized in bed, plus the institution of prophylactic anticoagulant therapy in a selected group of patients with a high predisposition to the development of thromboembolic diseases, should result in a significant reduction in disability and mortality from this theoretically preventable disease.
159 citations