Prospective double-arm study of fibrinolysis in surgical patients

Mary A. Kosir, Lisa Schmittinger, Lisa Barno-Winarski, Padimaja Duddella, Mark Pone, Anthony Perales, Patricia Lange, Linda K. Brish, Karen McGee, Karen Beleski, Julie Pawlak, E. Mammen, Nisha P. Sajahan, Robert Kozol

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background. During surgery, the balance between thrombosis and fibrinolysis is altered. Methods reported to increase fibrinolysis, such as compression devices, may reduce venous thrombosis. However, there are no prospective studies comparing methods and the effect on fibrinolysis. Materials and methods. In a prospective study, general surgical patients were randomized to either sequential compression devices (Group 1) or subcutaneous heparin (Group 2), and fibrinolysis factors were measured in order to determine the effect on the fibrinolysis system. Blood samples were drawn at a similar time of the day with the tourniquet off. Specifically, t-PA antigen, plasminogen activator inhibitor-1 (PAI-1), and D-dimer were measured preoperatively (preop) and on Postoperative Days (POD) 1 and 7 by the ELISA method. Fibrinolysis factors were reported as the mean ±SD and as percentage change from preoperative values. Noninvasive vascular studies were performed preop, and on POD 1, 7, and 30, by an examination of the infrainguinal venous system and external iliac veins in bilateral lower extremities. Nonambulatory patients were excluded from the study and DVT prophylaxis methods were initiated at surgery and used through POD 2. Results. For the 136 patients in the study, there were no differences in clinical characteristics such as age, surgical time (all >60 min), anesthesia type (general or spinal), type of surgical procedure, or other risk factors for DVT. Two DVTs occurred at POD 1 and 30 (both Group 2), and one pulmonary embolism in each group (POD 7 for Group 1; POD 1 for Group 2). For subjects without thrombosis, D-dimer changes were parallel for both groups, increasing through POD 7. Similarly, t-PA antigen levels rose from baseline on POD 1 in both groups, with a return toward baseline by POD 7. The PAI-1 levels increased on POD 1 in both groups, but severalfold more in Group 1 (compression devices). The elevation in PAI- 1 decreased by 50% in Group 1 by POD 7, while values returned to normal in Group 2. These changes were not significant using the Mann-Whitney test. Only three patients had thrombotic episodes so that data on changes in fibrinolysis factors are difficult to compare with the larger group. Conclusions. This is the first report of a prospective, randomized comparison of fibrinolysis factors using sequential compression devices in comparison to low dose unfractionated heparin in general surgical patients, and comparing postoperative values to preop. Both groups showed an enhanced fibrinolysis by elevation in t-PA antigen and D-dimer on POD 1, as expected when fibrinolysis occurs. While PAI-1 and t-PA work in parallel, the marked elevation of PAI-1 on POD 1 (although only slightly above reference values) and continuing into POD 7 for subjects using compression devices requires further inquiry. The elevation of PAI-1 in the face of elevated t-PA and D-dimer has been reported, but the comparison between patients using sequential compression devices and mini-dose heparin has not been reported. The reason for the elevation requires additional study into other influences on the synthesis, secretion, and/or function of PAI-1 that do not affect t-PA.

Original languageEnglish
Pages (from-to)96-101
Number of pages6
JournalJournal of Surgical Research
Volume74
Issue number1
DOIs
StatePublished - Jan 1 1998

Fingerprint

Fibrinolysis
Plasminogen Activator Inhibitor 1
Equipment and Supplies
Heparin
Antigens
Thrombosis
Activator Appliances
Prospective Studies
Iliac Vein
Tourniquets
Spinal Anesthesia
Operative Time
Pulmonary Embolism
Venous Thrombosis
General Anesthesia
Blood Vessels
Lower Extremity
Reference Values
Enzyme-Linked Immunosorbent Assay
fibrin fragment D

Keywords

  • DVT prophylaxis
  • Fibrinolysis
  • Sequential pneumatic compression devices
  • Surgery and DVT

ASJC Scopus subject areas

  • Surgery

Cite this

Kosir, M. A., Schmittinger, L., Barno-Winarski, L., Duddella, P., Pone, M., Perales, A., ... Kozol, R. (1998). Prospective double-arm study of fibrinolysis in surgical patients. Journal of Surgical Research, 74(1), 96-101. https://doi.org/10.1006/jsre.1997.5233

Prospective double-arm study of fibrinolysis in surgical patients. / Kosir, Mary A.; Schmittinger, Lisa; Barno-Winarski, Lisa; Duddella, Padimaja; Pone, Mark; Perales, Anthony; Lange, Patricia; Brish, Linda K.; McGee, Karen; Beleski, Karen; Pawlak, Julie; Mammen, E.; Sajahan, Nisha P.; Kozol, Robert.

In: Journal of Surgical Research, Vol. 74, No. 1, 01.01.1998, p. 96-101.

Research output: Contribution to journalArticle

Kosir, MA, Schmittinger, L, Barno-Winarski, L, Duddella, P, Pone, M, Perales, A, Lange, P, Brish, LK, McGee, K, Beleski, K, Pawlak, J, Mammen, E, Sajahan, NP & Kozol, R 1998, 'Prospective double-arm study of fibrinolysis in surgical patients', Journal of Surgical Research, vol. 74, no. 1, pp. 96-101. https://doi.org/10.1006/jsre.1997.5233
Kosir MA, Schmittinger L, Barno-Winarski L, Duddella P, Pone M, Perales A et al. Prospective double-arm study of fibrinolysis in surgical patients. Journal of Surgical Research. 1998 Jan 1;74(1):96-101. https://doi.org/10.1006/jsre.1997.5233
Kosir, Mary A. ; Schmittinger, Lisa ; Barno-Winarski, Lisa ; Duddella, Padimaja ; Pone, Mark ; Perales, Anthony ; Lange, Patricia ; Brish, Linda K. ; McGee, Karen ; Beleski, Karen ; Pawlak, Julie ; Mammen, E. ; Sajahan, Nisha P. ; Kozol, Robert. / Prospective double-arm study of fibrinolysis in surgical patients. In: Journal of Surgical Research. 1998 ; Vol. 74, No. 1. pp. 96-101.
@article{6f727fc29ccd44d6ab6e0d40a727f911,
title = "Prospective double-arm study of fibrinolysis in surgical patients",
abstract = "Background. During surgery, the balance between thrombosis and fibrinolysis is altered. Methods reported to increase fibrinolysis, such as compression devices, may reduce venous thrombosis. However, there are no prospective studies comparing methods and the effect on fibrinolysis. Materials and methods. In a prospective study, general surgical patients were randomized to either sequential compression devices (Group 1) or subcutaneous heparin (Group 2), and fibrinolysis factors were measured in order to determine the effect on the fibrinolysis system. Blood samples were drawn at a similar time of the day with the tourniquet off. Specifically, t-PA antigen, plasminogen activator inhibitor-1 (PAI-1), and D-dimer were measured preoperatively (preop) and on Postoperative Days (POD) 1 and 7 by the ELISA method. Fibrinolysis factors were reported as the mean ±SD and as percentage change from preoperative values. Noninvasive vascular studies were performed preop, and on POD 1, 7, and 30, by an examination of the infrainguinal venous system and external iliac veins in bilateral lower extremities. Nonambulatory patients were excluded from the study and DVT prophylaxis methods were initiated at surgery and used through POD 2. Results. For the 136 patients in the study, there were no differences in clinical characteristics such as age, surgical time (all >60 min), anesthesia type (general or spinal), type of surgical procedure, or other risk factors for DVT. Two DVTs occurred at POD 1 and 30 (both Group 2), and one pulmonary embolism in each group (POD 7 for Group 1; POD 1 for Group 2). For subjects without thrombosis, D-dimer changes were parallel for both groups, increasing through POD 7. Similarly, t-PA antigen levels rose from baseline on POD 1 in both groups, with a return toward baseline by POD 7. The PAI-1 levels increased on POD 1 in both groups, but severalfold more in Group 1 (compression devices). The elevation in PAI- 1 decreased by 50{\%} in Group 1 by POD 7, while values returned to normal in Group 2. These changes were not significant using the Mann-Whitney test. Only three patients had thrombotic episodes so that data on changes in fibrinolysis factors are difficult to compare with the larger group. Conclusions. This is the first report of a prospective, randomized comparison of fibrinolysis factors using sequential compression devices in comparison to low dose unfractionated heparin in general surgical patients, and comparing postoperative values to preop. Both groups showed an enhanced fibrinolysis by elevation in t-PA antigen and D-dimer on POD 1, as expected when fibrinolysis occurs. While PAI-1 and t-PA work in parallel, the marked elevation of PAI-1 on POD 1 (although only slightly above reference values) and continuing into POD 7 for subjects using compression devices requires further inquiry. The elevation of PAI-1 in the face of elevated t-PA and D-dimer has been reported, but the comparison between patients using sequential compression devices and mini-dose heparin has not been reported. The reason for the elevation requires additional study into other influences on the synthesis, secretion, and/or function of PAI-1 that do not affect t-PA.",
keywords = "DVT prophylaxis, Fibrinolysis, Sequential pneumatic compression devices, Surgery and DVT",
author = "Kosir, {Mary A.} and Lisa Schmittinger and Lisa Barno-Winarski and Padimaja Duddella and Mark Pone and Anthony Perales and Patricia Lange and Brish, {Linda K.} and Karen McGee and Karen Beleski and Julie Pawlak and E. Mammen and Sajahan, {Nisha P.} and Robert Kozol",
year = "1998",
month = "1",
day = "1",
doi = "10.1006/jsre.1997.5233",
language = "English",
volume = "74",
pages = "96--101",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - Prospective double-arm study of fibrinolysis in surgical patients

AU - Kosir, Mary A.

AU - Schmittinger, Lisa

AU - Barno-Winarski, Lisa

AU - Duddella, Padimaja

AU - Pone, Mark

AU - Perales, Anthony

AU - Lange, Patricia

AU - Brish, Linda K.

AU - McGee, Karen

AU - Beleski, Karen

AU - Pawlak, Julie

AU - Mammen, E.

AU - Sajahan, Nisha P.

AU - Kozol, Robert

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Background. During surgery, the balance between thrombosis and fibrinolysis is altered. Methods reported to increase fibrinolysis, such as compression devices, may reduce venous thrombosis. However, there are no prospective studies comparing methods and the effect on fibrinolysis. Materials and methods. In a prospective study, general surgical patients were randomized to either sequential compression devices (Group 1) or subcutaneous heparin (Group 2), and fibrinolysis factors were measured in order to determine the effect on the fibrinolysis system. Blood samples were drawn at a similar time of the day with the tourniquet off. Specifically, t-PA antigen, plasminogen activator inhibitor-1 (PAI-1), and D-dimer were measured preoperatively (preop) and on Postoperative Days (POD) 1 and 7 by the ELISA method. Fibrinolysis factors were reported as the mean ±SD and as percentage change from preoperative values. Noninvasive vascular studies were performed preop, and on POD 1, 7, and 30, by an examination of the infrainguinal venous system and external iliac veins in bilateral lower extremities. Nonambulatory patients were excluded from the study and DVT prophylaxis methods were initiated at surgery and used through POD 2. Results. For the 136 patients in the study, there were no differences in clinical characteristics such as age, surgical time (all >60 min), anesthesia type (general or spinal), type of surgical procedure, or other risk factors for DVT. Two DVTs occurred at POD 1 and 30 (both Group 2), and one pulmonary embolism in each group (POD 7 for Group 1; POD 1 for Group 2). For subjects without thrombosis, D-dimer changes were parallel for both groups, increasing through POD 7. Similarly, t-PA antigen levels rose from baseline on POD 1 in both groups, with a return toward baseline by POD 7. The PAI-1 levels increased on POD 1 in both groups, but severalfold more in Group 1 (compression devices). The elevation in PAI- 1 decreased by 50% in Group 1 by POD 7, while values returned to normal in Group 2. These changes were not significant using the Mann-Whitney test. Only three patients had thrombotic episodes so that data on changes in fibrinolysis factors are difficult to compare with the larger group. Conclusions. This is the first report of a prospective, randomized comparison of fibrinolysis factors using sequential compression devices in comparison to low dose unfractionated heparin in general surgical patients, and comparing postoperative values to preop. Both groups showed an enhanced fibrinolysis by elevation in t-PA antigen and D-dimer on POD 1, as expected when fibrinolysis occurs. While PAI-1 and t-PA work in parallel, the marked elevation of PAI-1 on POD 1 (although only slightly above reference values) and continuing into POD 7 for subjects using compression devices requires further inquiry. The elevation of PAI-1 in the face of elevated t-PA and D-dimer has been reported, but the comparison between patients using sequential compression devices and mini-dose heparin has not been reported. The reason for the elevation requires additional study into other influences on the synthesis, secretion, and/or function of PAI-1 that do not affect t-PA.

AB - Background. During surgery, the balance between thrombosis and fibrinolysis is altered. Methods reported to increase fibrinolysis, such as compression devices, may reduce venous thrombosis. However, there are no prospective studies comparing methods and the effect on fibrinolysis. Materials and methods. In a prospective study, general surgical patients were randomized to either sequential compression devices (Group 1) or subcutaneous heparin (Group 2), and fibrinolysis factors were measured in order to determine the effect on the fibrinolysis system. Blood samples were drawn at a similar time of the day with the tourniquet off. Specifically, t-PA antigen, plasminogen activator inhibitor-1 (PAI-1), and D-dimer were measured preoperatively (preop) and on Postoperative Days (POD) 1 and 7 by the ELISA method. Fibrinolysis factors were reported as the mean ±SD and as percentage change from preoperative values. Noninvasive vascular studies were performed preop, and on POD 1, 7, and 30, by an examination of the infrainguinal venous system and external iliac veins in bilateral lower extremities. Nonambulatory patients were excluded from the study and DVT prophylaxis methods were initiated at surgery and used through POD 2. Results. For the 136 patients in the study, there were no differences in clinical characteristics such as age, surgical time (all >60 min), anesthesia type (general or spinal), type of surgical procedure, or other risk factors for DVT. Two DVTs occurred at POD 1 and 30 (both Group 2), and one pulmonary embolism in each group (POD 7 for Group 1; POD 1 for Group 2). For subjects without thrombosis, D-dimer changes were parallel for both groups, increasing through POD 7. Similarly, t-PA antigen levels rose from baseline on POD 1 in both groups, with a return toward baseline by POD 7. The PAI-1 levels increased on POD 1 in both groups, but severalfold more in Group 1 (compression devices). The elevation in PAI- 1 decreased by 50% in Group 1 by POD 7, while values returned to normal in Group 2. These changes were not significant using the Mann-Whitney test. Only three patients had thrombotic episodes so that data on changes in fibrinolysis factors are difficult to compare with the larger group. Conclusions. This is the first report of a prospective, randomized comparison of fibrinolysis factors using sequential compression devices in comparison to low dose unfractionated heparin in general surgical patients, and comparing postoperative values to preop. Both groups showed an enhanced fibrinolysis by elevation in t-PA antigen and D-dimer on POD 1, as expected when fibrinolysis occurs. While PAI-1 and t-PA work in parallel, the marked elevation of PAI-1 on POD 1 (although only slightly above reference values) and continuing into POD 7 for subjects using compression devices requires further inquiry. The elevation of PAI-1 in the face of elevated t-PA and D-dimer has been reported, but the comparison between patients using sequential compression devices and mini-dose heparin has not been reported. The reason for the elevation requires additional study into other influences on the synthesis, secretion, and/or function of PAI-1 that do not affect t-PA.

KW - DVT prophylaxis

KW - Fibrinolysis

KW - Sequential pneumatic compression devices

KW - Surgery and DVT

UR - http://www.scopus.com/inward/record.url?scp=0031869018&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031869018&partnerID=8YFLogxK

U2 - 10.1006/jsre.1997.5233

DO - 10.1006/jsre.1997.5233

M3 - Article

VL - 74

SP - 96

EP - 101

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -