Key result
Major surgery induced significant hypercoagulability beginning on postoperative day 2, which was not reliably reflected by clinically used global coagulation tests.
Why the study?
How do procoagulant factors change postoperatively, and can standard coagulation tests reliably detect hypercoagulability after major surgery?
Observational (n=51)
How do procoagulant factors change postoperatively, and can standard coagulation tests reliably detect hypercoagulability after major surgery?
Significant hypercoagulability develops starting on postoperative day 2 after major surgery, but standard global coagulation tests and point-of-care devices do not reliably detect this state.
Answers are grounded in this paper and cite their sources.
Standard tests may miss postoperative hypercoagulability; leaves open whether sensitive assays improve risk stratification.
Surgical patients are primarily at an increased risk of perioperative bleeding; however, after surgery, these patients develop hypercoagulability that favors thrombotic events. Currently, the time course of postoperative coagulation is not well characterized. Thus, the aim of the present study was to provide a detailed description of the changes in procoagulant factors in patients after major surgery and to evaluate coagulation tests based on their ability to detect hypercoagulability. Fifty-one consecutive patients undergoing different types of major surgery were analyzed. Blood samples were taken preoperatively and on postoperative days (PODs) 1, 2, 3, and 6. In addition to prothrombin time (PT) and activated partial thromboplastin time (aPTT), all PT-dependent and aPTT-dependent clotting factors, von Willebrand factor (vWF), and fibrinogen were obtained, and thrombelastometry and multiplate electrode aggregometry (MEA) were performed. On POD 1, the majority of clotting factors, including factors II, VII, X, XI, and XII, showed a significant decrease from baseline. Factors II, X, XI, and XII remained significantly reduced until POD 3. In contrast, starting on POD 2, fibrinogen, factor VIII, and vWF continuously increased. No relevant changes were found for PT or aPTT. Thrombelastometry revealed a continuous increase in clot firmness, and MEA demonstrated an increase in platelet aggregation on POD 6. However, absolute values remained within normal ranges, and only serial measurements showed hypercoagulation. Beginning on POD 2 after major surgery, significant hypercoagulability developed in patients. However, clinically used global coagulation tests and point-of-care devices did not reliably reflect the hypercoagulatory state.
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Lison et al. (2011) conducted an observational in Major surgery (n=51). Major surgery vs. Preoperative baseline was evaluated on Changes in procoagulant factors and coagulation tests. Major surgery induced significant hypercoagulability beginning on postoperative day 2, which was not reliably reflected by clinically used global coagulation tests.
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