Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery

David Lubarsky, Stacy D. Fisher, Thomas F. Slaughter, Cynthia L. Green, Catherine K. Lineberger, J. Rex Astles, Charles S. Greenberg, W. Warriner Inge, Mitchell W. Krucoff

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

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. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish
Pages (from-to)136-141
Number of pages6
JournalJournal of Clinical Anesthesia
Volume12
Issue number2
DOIs
StatePublished - Mar 1 2000
Externally publishedYes

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Keywords

  • Anesthesia
  • D-dimer
  • Electrocardiography
  • Fibrinolysis
  • Ischemia
  • Surgery
  • Vascular

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Lubarsky, D., Fisher, S. D., Slaughter, T. F., Green, C. L., Lineberger, C. K., Astles, J. R., Greenberg, C. S., Inge, W. W., & Krucoff, M. W. (2000). Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery. Journal of Clinical Anesthesia, 12(2), 136-141. https://doi.org/10.1016/S0952-8180(00)00126-4