Compensated activation of coagulation in patients with abdominal aortic aneurysm: effects of heparin treatment prior to elective surgery

2004 ◽  
Vol 92 (11) ◽  
pp. 997-1002 ◽  
Author(s):  
Jacek Szmidt ◽  
Krzystof Bojakowski ◽  
Tomasz Grzela ◽  
Magorzata Palester-Chlebowczyk ◽  
Maria Jelenska
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Reference Group ◽  
Elective Surgery ◽  
Operation Time ◽  
Fibrinogen Concentration ◽  
Excessive Bleeding ◽  
Prothrombin Fragment ◽  
Abdominal Aortic ◽  
D Dimer

SummaryElective surgery of abdominal aortic aneurysm (AAA) sometimes leads to excessive bleeding and disseminated intravascular coagulation (DIC), even in patients with normal preoperative coagulation parameters. Coagulation screen, performed routinely before surgery is of limited value in the assessment of compensated activation of the haemostatic system. In this study, we used a number of additional tests (D-dimer, prothrombin fragment 1+2, antithrombin, and activation of fibrinolysis in the platelet poor plasma) for the diagnosis of compensated activation of the haemostatic system in AAA-patients. Ddimer and marker of thrombin generation (prothrombin fragment 1+2) positively correlated with each other (r = 0.768, P < 0.001). Out of 71 AAA patients, 15 patients had normal global coagulation times, but those with a Ddimer concentration above 3000 ng/ml were selected for preoperative low molecular weight heparin (LMWH) treatment. Administration of LMWH diminished coagulation abnormalities (D-dimer and prothrombin fragment 1+2 decreased significantly) and resulted in the increase of platelet number and fibrinogen concentration, indicating their previous consumption. Despite differences in aneurysm diameters between the groups of 15 LMWH treated patients (mean 70.9 ± 16 mm) and the reference group of 20 untreated AAA patients (mean 52.3 ± 8.0 mm), intraoperative parameters (operation time, blood loss and transfusion demands) were similar.

Plasma D-dimer as a predictor of the progression of abdominal aortic aneurysm

2016 ◽  
Vol 14 (11) ◽  
pp. 2298-2303 ◽  
Author(s):  
E. Vele ◽  
A. Kurtcehajic ◽  
E. Zerem ◽  
J. Maskovic ◽  
E. Alibegovic ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aortic ◽  
D Dimer

scholarly journals Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253327
Author(s):  
Lois G. Kim ◽  
Michael J. Sweeting ◽  
Morag Armer ◽  
Jo Jacomelli ◽  
Akhtar Nasim ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Screening Programme ◽  
Elective Surgery ◽  
Discrete Event ◽  
Drop Out ◽  
Abdominal Aortic ◽  
Related Service ◽  
The Impact ◽  
Related Mortality

Background The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume. Methods We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population. Findings Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5–5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes. Interpretation Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.

Interplay between Coagulation and Inflammation in Open and Endovascular Abdominal Aortic Aneurysm Repair — Impact of Intra-Aneurysmal Thrombus

2007 ◽  
Vol 96 (3) ◽  
pp. 229-235 ◽  
Author(s):  
P.-S. Aho ◽  
T. Niemi ◽  
A. Piilonen ◽  
R. Lassila ◽  
R. Renkonen ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aortic Aneurysm Repair ◽  
Open Group ◽  
Intraluminal Thrombus ◽  
Computed Tomography Images ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
D Dimer

Aims: Our aim was to compare hemostatic and inflammatory mechanisms in abdominal aortic aneurysm (AAA) patients after open surgery (OPEN) and endovascular AAA repair (ENDO). Subjects and Methods: From the 32 consecutive AAA patients recruited, 17 represented ENDO and 15 OPEN. The intra-aneurysmal thrombus was removed during OPEN, but stayed intact after ENDO. The pre-operative volume of the intra-aneurysmal thrombus was calculated from computed tomography images. Markers of coagulation and inflammation were studied pre-operatively, at one, two, three, four and seven days and at three months postoperatively. Results: Preoperative upregulation of F 1 + 2, TAT and D-dimer was evident in both groups. The volume of intra-aneurysmal thrombus correlated with CRP (β=0.62, p=0.001), IL-6 (β=0.60, p=0.001) and PAI-1 ag (β=0.51, p=0.007). Surgery further enhanced inflammation, coagulation and fibrinolysis. IL-6 increased in both groups, but the increases of CRP and PIIINP were higher in the OPEN group. Postoperative CRP correlated with the intra-aneurysmal thrombus volume in the ENDO group. At three months D-dimer (p<0.05) was higher than pre-operatively in the ENDO, in contrast to the OPEN group. Conclusion: Preoperatively both prothrombotic and fibrinolytic mechanisms are activated in patients with AAA. Intraluminal thrombus induces prothrombotic and inflammatory interactions, which persist after endovascular aortic aneurysm repair.

Plasma D-dimer and abdominal aortic aneurysm

2010 ◽  
Vol 126 (6) ◽  
pp. e451-e452
Author(s):  
Hisato Takagi ◽  
Hideaki Manabe ◽  
Masafumi Matsui ◽  
Shin-nosuke Goto ◽  
Takuya Umemoto
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aortic ◽  
D Dimer

Plasma D-dimer as a predictor of intraluminal thrombus burden and progression of abdominal aortic aneurysm

Life Sciences ◽  
2020 ◽  
Vol 240 ◽  
pp. 117069
Author(s):  
Ying-nan Fan ◽  
Xiao Ke ◽  
Zhi-long Yi ◽  
Yong-qing Lin ◽  
Bing-qing Deng ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Intraluminal Thrombus ◽  
Abdominal Aortic ◽  
D Dimer

scholarly journals Grey Relational Analysis of Benefit of Surgical Management for Abdominal Aortic Aneurysm

2014 ◽  
Vol 99 (2) ◽  
pp. 189-194 ◽  
Author(s):  
Kaifeng Wang ◽  
Shiyan Ren ◽  
Songyi Qian ◽  
Peng Liu
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Grey Relational Analysis ◽  
Open Repair ◽  
Operation Time ◽  
Relational Analysis ◽  
Abdominal Aortic ◽  
All Cause Mortality ◽  
Grey Relational

Abstract Grey relational analysis was used to compare the long-term outcomes of endovascular repair (EVAR) versus open repair for patients with abdominal aortic aneurysm (AAA). Patients with AAA undergoing open repair (n = 133) or EVAR (n = 88) from July 1995 to January 2009 were studied retrospectively. Compared with EVAR, longer periods of postoperative intubation and hospital stay (P &lt; 0.001) were required for open repair. The operation time was significantly longer in open surgery than in EVAR (P &lt; 0.001). Patients in the open repair group required larger volumes of intraoperative blood transfusion than those in EVAR (P &lt; 0.001), and they had more of a trend of cardiac failure after surgery than those in the EVAR group. The operative mortality was similar in both groups. On follow-up, the all-cause mortality and the rates of ischemic legs within 5 years had no significant differences between the 2 procedures (P &gt; 0.05). The grey relational grades in EVAR and open repair were 0.673 and 0.936, respectively. Compared with open repair, patients with AAAs undergoing EVAR had fewer complications in the short term and had a similar all-cause mortality in the long term.

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