Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery.

Published

Journal Article

STUDY OBJECTIVES: To evaluate the relationship between perioperative ischemia and serial concentrations of D-dimer, which is a sensitive and specific marker of fibrinolytic activity. Myocardial ischemia and infarction are well-recognized complications of peripheral vascular surgery. We hypothesized that patients at increased risk of perioperative myocardial ischemia might be identified preoperatively by abnormal hemostatic indices. DESIGN: Prospective clinical outcomes study. SETTING: A 1,124-bed tertiary care medical center. PATIENTS: 42 ASA physical status II, III, and IV patients undergoing peripheral vascular surgery. INTERVENTIONS: Serial D-dimer concentrations were measured preoperatively, and at 24 and 72 hours postoperatively. Continuous 12-lead ST-segment monitoring (Mortara Instrument, Inc., Milwaukee, WI) was performed with the acquisition of a 12-lead ECG every 20 seconds for 72 hours. MEASUREMENTS AND MAIN RESULTS: D-dimer measurements were performed in duplicate using the Dimer Gold assay (American Diagnostica, Greenwich CT). Ischemic episodes, as defined by continuous 12-lead ST-segment monitoring, occurred in 49% of patients. There were no demographic differences between ischemic and nonischemic groups. Although baseline D-dimer concentrations were not statistically significantly different between groups, patients experiencing perioperative myocardial ischemia generated significantly less D-dimer during the perioperative period (p = 0. 014). CONCLUSIONS: PATIENTS with an impaired fibrinolytic response, as defined by reduced generation of D-dimer, experienced an increased incidence of perioperative myocardial ischemia.

Full Text

Duke Authors

Cited Authors

  • Lubarsky, DA; Fisher, SD; Slaughter, TF; Green, CL; Lineberger, CK; Astles, JR; Greenberg, CS; Inge, WW; Krucoff, MW

Published Date

  • March 2000

Published In

Volume / Issue

  • 12 / 2

Start / End Page

  • 136 - 141

PubMed ID

  • 10818328

Pubmed Central ID

  • 10818328

Electronic International Standard Serial Number (EISSN)

  • 1873-4529

International Standard Serial Number (ISSN)

  • 0952-8180

Digital Object Identifier (DOI)

  • 10.1016/s0952-8180(00)00126-4

Language

  • eng