Effect of endovascular and open abdominal aortic aneurysm repair on thrombin generation and fibrinolysis

• Published in: Journal of vascular surgery 2013, Vol.57 (1), p.103-107
• Main Authors: Abdelhamid, Mohamed F., MBBCH (Hon), MSc, MRCSEd, Davies, Robert S.M., MRCS, Vohra, Rajiv K., MD, FRCS, Adam, Donald J., MD, FRCSEd, Bradbury, Andrew W., BSc, MBA, MD, FRCSEd
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antithrombin III; Aortic Aneurysm, Abdominal - blood; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Biomarkers - blood; Blood Vessel Prosthesis Implantation - adverse effects; Case-Control Studies; Endovascular Procedures - adverse effects; Female; Fibrinolysis; Humans; Male; Middle Aged; Peptide Fragments - blood; Peptide Hydrolases - blood; Plasminogen Inactivators - blood; Prothrombin; Surgery; Thrombin - metabolism; Thrombosis - blood; Thrombosis - etiology; Time Factors; Tissue Plasminogen Activator - blood; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.07.024

Background Abdominal aortic aneurysm (AAA) is associated with a prothrombotic diathesis that may increase the risk of cardiovascular events. This diathesis is exacerbated in the short term by open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR). However, the effect of EVAR and OAR on coagulation and fibrinolysis in the medium and long term is poorly understood. The purpose of this study was to investigate the medium-term effects of EVAR and OAR on thrombin generation, neutralization, and fibrinolysis. Methods Prothrombin fragment (PF)1 + 2, thrombin antithrombin (TAT) complex, plasminogen activator inhibitor (PAI) activity, and tissue-plasminogen activator (t-PA) antigen were measured in eight age-matched controls (AMCs), 29 patients with AAA immediately before (preoperatively) and 12 months after EVAR (post-EVAR), and in 11 patients at a mean of 16 months after OAR (post-OAR). Results Preoperatively, PF1 + 2 levels were significantly higher in patients with AAAs than in AMC. PF1 + 2 levels post-EVAR and post-OAR were significantly lower than preoperative values and similar to AMC. There was no significant difference in TAT, PAI, or t-PA between AMC, AAA preoperatively, and post-EVAR. Post-OAR, PAI activity was significantly higher than in preoperative patients. Conclusions AAA is associated with increased thrombin generation without upregulation of fibrinolysis. The prothrombotic, hypofibrinolytic diathesis observed in patients with AAA returns toward normal in the medium term after EVAR and OAR, although there is a trend toward decreased fibrinolysis post-OAR.