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Anaesthesia. 2005 Dec;60(12):1162-7. Related Articles, Links
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Association between early postoperative coagulation activation and peri-operative myocardial ischaemia in patients undergoing vascular surgery.

Bottiger BW, Snyder-Ramos SA, Lapp W, Motsch J, Aulmann M, Schweizer M, Layug EL, Martin E, Mangano DT; the investigators of the Multicenter Study of Perioperative Ischemia (MCSPI) Research Group, Inc. and the Ischemia Research and Education Foundation.

Professor & Vice-Chairman, Department of Anaesthesiology, University of Heidelberg, Germany.

Summary 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.