TY - JOUR
T1 - Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery
AU - Lubarsky, David
AU - Fisher, Stacy D.
AU - Slaughter, Thomas F.
AU - Green, Cynthia L.
AU - Lineberger, Catherine K.
AU - Astles, J. Rex
AU - Greenberg, Charles S.
AU - Inge, W. Warriner
AU - Krucoff, Mitchell W.
PY - 2000/1/1
Y1 - 2000/1/1
N2 - 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.
AB - 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.
KW - Anesthesia
KW - D-dimer
KW - Electrocardiography
KW - Fibrinolysis
KW - Ischemia
KW - Surgery
KW - Vascular
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U2 - 10.1016/S0952-8180(00)00126-4
DO - 10.1016/S0952-8180(00)00126-4
M3 - Article
C2 - 10818328
AN - SCOPUS:0034057719
VL - 12
SP - 136
EP - 141
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
SN - 0952-8180
IS - 2
ER -