Myocardial injury after non-cardiac surgery and per operative fibrin metabolism in patients undergoing hip-fracture surgery: an observational study.

Autor: Wahlstrøm KL; Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark., Ekeloef S; Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark., Gögenur I; Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark.; Institute for Clinical Medicine, Copenhagen University, Denmark., Münster AB; Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.; Department of Clinical Biochemistry, Regional Hospital West Jutland, Holstebro, Denmark.
Jazyk: angličtina
Zdroj: Scandinavian journal of clinical and laboratory investigation [Scand J Clin Lab Invest] 2023 Sep; Vol. 83 (5), pp. 299-308. Date of Electronic Publication: 2023 Aug 16.
DOI: 10.1080/00365513.2023.2220970
Abstrakt: Myocardial injury after non-cardiac surgery (MINS) is associated with a 2-3-fold increased risk of subsequent major cardiovascular events and postoperative mortality. The pathological mechanism behind MINS is not fully uncovered. We hypothesized that patients with MINS following hip fracture surgery would have an altered haemostatic balance pre- and postoperative compared with patients without MINS. This was investigated in a prospective single-centre observational study including patients consecutively. The outcomes were changes in thrombin generation, fibrinogen/fibrin turnover, tissue plasminogen activator, plasminogen activator inhibitor-1 and fibrin structure measurements in patients developing MINS and patients who did not. Outcomes were measured preoperatively and two hours postoperatively. Seventy-two patients were included whereof 26 (36%) patients developed MINS. D-dimer delta values were significantly higher in patients developing MINS than in patients who did not ( p  = 0.01). After adjusting for age, sex, smoking, alcohol abuse, atrial fibrillation, anticoagulant medication preoperative CRP, preoperative creatinine and duration of surgery, the association remained significant ( p  = 0.04). There were no significant changes in thrombin generation, in markers of fibrinogen/fibrin turnover besides D-dimer, or in fibrin structure measurements pre- and postoperatively between patients with and without MINS. As such, a relationship between the coagulative and fibrinolytic activity and MINS cannot be ruled out in patients with MINS after hip fracture surgery. Registration: The study was an observational sub-study to a multicentre randomised clinical trial registered at ClinicalTrials.gov (NCT02344797).
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje