OBJECTIVE: Patients undergoing open repair of asymptomatic abdominal aortic aneurysms (AAA) demonstrate a prothrombotic state that initially deteriorates in the peri-operative period before improving beyond the pre-operative state. We hypothesised that a similar haemostatic improvement occurs following endovascular AAA repair (EVAR) and that the initial prothrombotic derangement may increase the risk of myocardial injury. METHODS: 60 patients[57 men; median(IQR) age, 77 (72-82) years] underwent EVAR. Patients were assessed at baseline, 24-hours and 1-month post-procedure. Thrombin-antithrombin III-complex (TAT), tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1), and soluble (s) P-selectin levels were assessed as biomarkers of coagulation, fibrinolysis and platelet activity, respectively. Cardiac Troponin T (cTnT) levels were assessed as a biomarker of myocardial injury (MI). RESULTS: An increase in sP-selectin levels occurred between baseline[median(IQR), 80.5(68-128) ng/ml], 24-hours[median(IQR), 89.5(73-112)ng/ml; p=0.003] and 1-month[median(IQR), 110(89-143)ng/ml; p=<0.0001] post-EVAR. There was a trend towards increased TAT levels at 24-hours[median(IQR), 21.65(13-33.1)μg/l; p=0.069] compared to pre-operation[median(IQR), 7.15(4.7-31.3)μg/l] followed by a significant decrease at 1-month[median(IQR), 8.1 (5.4-14.85)μg/l; p=<0.0001]. cTnT levels were raised (>0.03ng/ml) in 16% of patients. There was a positive correlation between cTnT and TAT levels at 24-hours post-EVAR(r=0.38, p=0.039, Kendall-tau-B=0.26) CONCLUSION: These novel data suggest that the peri-operative pro-thrombotic state following EVAR may be associated with an increased risk of MI.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:566064 |
| Date | January 2012 |
| Creators | Davies, Robert |
| Publisher | University of Birmingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://etheses.bham.ac.uk//id/eprint/3727/ |
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