Abstract
Vasopressin (aVP) infusions in man that simulate physiological concentrations in plasma produce increases inboth factor VIII and plasminogen activator activity (PAA) and we have found evidence that aVP release contributes to the activation of coagulation during abdominal surgery. The aimof this study was to investigate whether aVP has a similar role in theregulation of haemostasis during hipsurgery. Venous blood samples were taken for FVIII:C, FVIII RiCof, vWF:Ag,fibrinopeptide A (FPA), ECLT, platelet aggregation in whole blood andaVPfrom separate venepuncture sites in 7 patients undergoing elective hip surgery. Samples were taken pre-operatively, post induction of anaesthesia, at skin incision, during divisionof the femoral neck, reaming of the acetabulum, cementing of the prosthesisand on thefirst post-operative day. FVIII:C increased during the operation from a geometric mean of 70%pre-operativelyto 109% (p < 0.05) post-operativgly.vWF:Ag and FVIII RiCof rose in a similar manner. PAA (106 /ECLT2) rose significantly from 12 units pre-operatively to a peak value of 167 units(p< 0.001) at prosthesis cementing,andpost-operatively fell to subnoral levels. FPA concentrations followed a similar pattern rising from13 pmol/ml to 58 psmol/ml (p < 0.02)atprosthesis cementing, and falling to9pmol/ml post-operatively. PlasmaaVP rosefrom 0.5pg/ml pre-operatively to 40pg/ml (p < 0.01) at division of the femoral neck, and returned to0.5 pg/ml post-operatively. There were no changes in platelet aggregation in whole blood using a single doseof 1.5 μM ADP. These results are similarto those we have observed duringabdominal surgery. They confirm thaduring surgery, thrombin generation occurs with increased PAA,both of which are preceded by a risein aVP. This isconsistent with the hypothesisthat aVP is an important mediatorof changes in haemostatic function occurringduring surgery, and we are now investigating the relationship between intra-operative changesin haemostaticfunctionand risk of post-operative DVT.
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