Document Detail


Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair.
MedLine Citation:
PMID:  21975058     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Abdominal aortic aneurysm (AAA) is a chronic inflammatory condition associated with a prothrombotic, hypofibrinolytic diathesis that may increase the risk of cardiovascular events. The effect of endovascular aneurysm repair (EVAR) on this prothrombotic diathesis is not fully understood, especially over the medium and long term. A better understanding of these postintervention changes may improve the risk of cardiovascular complications in the long term. The purpose of this study was to examine thrombin generation, fibrinolysis, platelet and endothelial activation, and the inflammatory response during the 12 months following EVAR.
METHODS: Twenty-nine patients (mean age, 76.9 years) undergoing EVAR for AAA (mean diameter 6.9 cm) had prothrombin fragment (PF) 1 + 2, thrombin-antithrombin complex (TAT), plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator (t-PA) activity and antigen, soluble P- and E-selectin, and highly sensitive C-reactive protein (hsCRP) measured before and at 24 hours, and 1, 6, and 12 months after surgery.
RESULTS: PF1 + 2 were markedly elevated prior to EVAR and remained so at 24 hours and 1 month, but had decreased significantly at 6 and 12 months. TAT was also elevated prior to EVAR and increased still further by 24 hours, but fell to below baseline levels thereafter. PAI activity and t-PA antigen were normal prior to EVAR, increased significantly at 24 hours, and then fell to baseline levels. t-PA activity was only detectable at 1 and 6 months; there was a significant rise in soluble P- and E-selectin after EVAR, which was sustained for 12 months. hsCRP increased transiently in response to EVAR but returned to preoperative levels by 1 month.
CONCLUSIONS: The prothrombotic, hypofibrinolytic diathesis associated with AAA is normalized 12 months after EVAR. This beneficial systemic effect of EVAR for AAA disease may help protect patients against future thromboembolic cardiovascular events.
Authors:
Mohamed F Abdelhamid; Robert S M Davies; Donald J Adam; Rajiv K Vohra; Andrew W Bradbury
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-05
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-20     Completed Date:  2012-02-02     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom; Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. m.f.abdelhamid@btinternet.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antithrombin III
Aortic Aneurysm, Abdominal / blood,  complications,  immunology,  surgery*
Biological Markers / blood
Blood Platelets / metabolism*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / instrumentation
C-Reactive Protein / metabolism
E-Selectin / blood
Endothelial Cells / metabolism*
Endovascular Procedures* / instrumentation
England
Female
Fibrinolysis*
Humans
Inflammation Mediators / blood*
Male
Middle Aged
P-Selectin / blood
Peptide Fragments / blood
Peptide Hydrolases / blood
Plasminogen Activator Inhibitor 1 / blood
Prospective Studies
Prosthesis Design
Prothrombin
Stents
Thrombin / metabolism*
Time Factors
Tissue Plasminogen Activator / blood
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/E-Selectin; 0/Inflammation Mediators; 0/P-Selectin; 0/Peptide Fragments; 0/Plasminogen Activator Inhibitor 1; 0/SELE protein, human; 0/SELP protein, human; 0/SERPINE1 protein, human; 0/antithrombin III-protease complex; 0/prothrombin fragment 1.2; 9000-94-6/Antithrombin III; 9001-26-7/Prothrombin; 9007-41-4/C-Reactive Protein; EC 3.4.-/Peptide Hydrolases; EC 3.4.21.5/Thrombin; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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