Document Detail


Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery.
MedLine Citation:
PMID:  10818328     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
D A Lubarsky; S D Fisher; T F Slaughter; C L Green; C K Lineberger; J R Astles; C S Greenberg; W W Inge; M W Krucoff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  12     ISSN:  0952-8180     ISO Abbreviation:  J Clin Anesth     Publication Date:  2000 Mar 
Date Detail:
Created Date:  2000-07-06     Completed Date:  2000-07-06     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  136-41     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Antifibrinolytic Agents / blood*
Biological Markers / blood
Chi-Square Distribution
Electrocardiography, Ambulatory
Female
Fibrin Fibrinogen Degradation Products / analysis*
Fibrinolysis / drug effects*
Follow-Up Studies
Humans
Incidence
Intraoperative Complications
Male
Middle Aged
Myocardial Ischemia / etiology*
Outcome Assessment (Health Care)
Prospective Studies
Risk Factors
Vascular Surgical Procedures / adverse effects*
Chemical
Reg. No./Substance:
0/Antifibrinolytic Agents; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D

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