Abstract
PurposeDuring the perioperative period, coagulofibrinolytic activation occurs, which occasionally results in thromboembolic complications. However, natural perioperative coagulofibrinolytic responses have not been well investigated. The present study examined perioperative coagulofibrinolytic changes and their association with the development of venous thromboembolism (VTE).MethodsWe retrospectively analyzed the changes in coagulofibrinolytic markers for 7 days in 70 patients undergoing elective colorectal surgery. To explore the natural coagulofibrinolytic response, we investigated patients not undergoing perioperative chemical thromboprophylaxis.ResultsCoagulation activation occurred from just after surgery to postoperative day (POD) 1, followed by a gradual decrease, but persisted to even POD 7. Fibrinolytic activity showed a tri-phasic response: activation, shutdown and reactivation. Consequently, fibrin/fibrinogen degradation product (FDP) and D-dimer levels continued to increase until POD 7. The development of deep vein thrombosis (DVT) was observed in 11 patients (15.7%). Postoperative sustained hyper-coagulation [soluble fibrin (SF) or thrombin–antithrombin complex (TAT) values on POD 7 > their normal limits] was significantly associated with the development of DVT (SF, p < 0.001; TAT, p = 0.001).ConclusionWe found initial coagulation activation and a tri-phasic response of fibrinolytic activity after colorectal surgery. Thus, physicians need to pay attention to these responses when attempting to prevent or treat VTE.
Highlights
Physiological coagulation and fibrinolysis maintain hemostatic equilibrium under the delicate balance of bleeding and thrombus formation during the perioperative period [1]
The present study examined the changes in coagulofibrinolytic markers during the perioperative period of colorectal surgery in patients with no chemical thromboprophylaxis, which will allow us to understand the changes in coagulofibrinolytic markers without any influence from pharmacological interventions
We evaluated the perioperative changes in coagulofibrinolytic markers in colorectal surgery patients who did not receive perioperative chemical thromboprophylaxis
Summary
Physiological coagulation and fibrinolysis maintain hemostatic equilibrium under the delicate balance of bleeding and thrombus formation during the perioperative period [1]. Perioperative bleeding increases the risk of reoperation and the duration of hospital stay [2]. Thrombotic complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), are infrequent but result in severe morbidity and mortality after surgery [3]. The coagulofibrinolytic status during the perioperative period changes in response to bleeding, thrombus formation and many other factors, including even surgical stress itself [4,5,6]. It is necessary to evaluate the precise perioperative changes in coagulofibrinolytic markers according to different surgical techniques and conditions
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