Changes in Coagulofibrinolysis followed by Surgery under the Use of Tourniquet on a lower Extremity

Abstract

44 patients underwent surgery on a lower extremity under the use of tourniquet. Blood samples were obtained from the radial artery and the femoral vein on the involved leg, at the time of the inflation of tourniquet and one hour after its release. Activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fbg), antithrombin III (AT III), solubule fibrin monomer complex (SFMC), thrombin-antithrombin III complex (TAT), D-dimer, plasminogen (Plg), α2-plasmin-inhibiter (PI) and plasmin-plasmin inhibitor complex (PIC) were measured as analyses of coagulofibrinolysis. Total CK activity (CK), CK isoform ratio (IR) and myoglobin (Mb) were measured as a indicator of tissue injury.TAT denoted always a significantly higher value in venous sample. After the release of tourniquet, APTT shortened and PT ratio decreased both significantly. Fbg and AT III showed significant decreases and TAT significantly increased. Plg and PI showed significant decreases and PIC significantly increased. CK, IR and Mb showed significant increases. TAT showed positive correlations with CK, IR and Mb. PIC showed positive correlation with CK, IR and Mb. Only IR in venous sample was correlated with the duration of tourniquet.The values of APTT, PT, Fbg, AT III, TAT, Plg, PI and PIC suggest changes caused by a local hypercoagulofibrinolytic state. We should follow serial changes of these values to estimate the coagulofibrinolytic system in the patient with a local hypercoagulofibrinolytic state.