Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state

P. Collins, Isobel Ford, Michael Greaves, Ewan MacAulay, Julie Brittenden

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Platelet and coagulation activation are implicated in the increased incidence of ischaemic events seen in patients with peripheral arterial disease. This study aimed to assess the effect of surgical revascularisation on platelet aggregation and coagulation in patients with severe limb ischaemia (SLI). Twenty-two patients had blood samples taken: prior to surgery, on reperfusion, 2, 24 and 48 h post-surgery. Platelet aggregation through COX-mediated and thrombin receptor activator peptide (TRAP)-stimulated GPIIb/IIIa pathways was measured by the Ultegra point of care system. Thrombin-antithrombin III Complex (TAT) and D-dimer were measured by ELISA. COX-mediated aggregation increased significantly at reperfusion and remained elevated at 24 h [median increase from baseline of 9% (range -16 to 33%) P = 0.011]. TRAP-stimulated aggregation increased significantly at reperfusion and remained elevated at 2 h post-surgery [median increase 18% (range -71 to 45%); P = 0.007]. TAT levels were significantly elevated from reperfusion and remained so at 48 h (P < 0.003), whereas D-dimer only increased at 24 h (P = 0.014). For the first time, we have demonstrated that in patients with SLI, platelet aggregation is increased following surgery and there is a mismatch in the balance between the coagulation and fibrinolytic pathways despite the use of aspirin and heparin. Thus in the early postoperative these patients exhibit a pro-thrombotic state.

Original languageEnglish
Pages (from-to)311-317
Number of pages7
JournalPlatelets
Volume17
Issue number5
DOIs
Publication statusPublished - 2006

Keywords

  • platelet aggregation
  • thrombin-antithrombin
  • D-dimer
  • surgical revascularisation
  • peripheral arterial disease
  • vascular surgery
  • carotid endarterectomy
  • myocardial infarction
  • platelet activation
  • P-selectin
  • aspirin resistance
  • coagulation
  • heparin
  • stress

Cite this

Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state. / Collins, P.; Ford, Isobel; Greaves, Michael; MacAulay, Ewan; Brittenden, Julie.

In: Platelets, Vol. 17, No. 5, 2006, p. 311-317.

Research output: Contribution to journalArticle

Collins, P. ; Ford, Isobel ; Greaves, Michael ; MacAulay, Ewan ; Brittenden, Julie. / Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state. In: Platelets. 2006 ; Vol. 17, No. 5. pp. 311-317.
@article{3d699efe2a874382ac8e0d48e81a08a1,
title = "Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state",
abstract = "Platelet and coagulation activation are implicated in the increased incidence of ischaemic events seen in patients with peripheral arterial disease. This study aimed to assess the effect of surgical revascularisation on platelet aggregation and coagulation in patients with severe limb ischaemia (SLI). Twenty-two patients had blood samples taken: prior to surgery, on reperfusion, 2, 24 and 48 h post-surgery. Platelet aggregation through COX-mediated and thrombin receptor activator peptide (TRAP)-stimulated GPIIb/IIIa pathways was measured by the Ultegra point of care system. Thrombin-antithrombin III Complex (TAT) and D-dimer were measured by ELISA. COX-mediated aggregation increased significantly at reperfusion and remained elevated at 24 h [median increase from baseline of 9{\%} (range -16 to 33{\%}) P = 0.011]. TRAP-stimulated aggregation increased significantly at reperfusion and remained elevated at 2 h post-surgery [median increase 18{\%} (range -71 to 45{\%}); P = 0.007]. TAT levels were significantly elevated from reperfusion and remained so at 48 h (P < 0.003), whereas D-dimer only increased at 24 h (P = 0.014). For the first time, we have demonstrated that in patients with SLI, platelet aggregation is increased following surgery and there is a mismatch in the balance between the coagulation and fibrinolytic pathways despite the use of aspirin and heparin. Thus in the early postoperative these patients exhibit a pro-thrombotic state.",
keywords = "platelet aggregation, thrombin-antithrombin, D-dimer, surgical revascularisation, peripheral arterial disease, vascular surgery, carotid endarterectomy, myocardial infarction, platelet activation, P-selectin, aspirin resistance, coagulation, heparin, stress",
author = "P. Collins and Isobel Ford and Michael Greaves and Ewan MacAulay and Julie Brittenden",
year = "2006",
doi = "10.1080/09537100600746540",
language = "English",
volume = "17",
pages = "311--317",
journal = "Platelets",
issn = "0953-7104",
publisher = "Informa Healthcare",
number = "5",

}

TY - JOUR

T1 - Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state

AU - Collins, P.

AU - Ford, Isobel

AU - Greaves, Michael

AU - MacAulay, Ewan

AU - Brittenden, Julie

PY - 2006

Y1 - 2006

N2 - Platelet and coagulation activation are implicated in the increased incidence of ischaemic events seen in patients with peripheral arterial disease. This study aimed to assess the effect of surgical revascularisation on platelet aggregation and coagulation in patients with severe limb ischaemia (SLI). Twenty-two patients had blood samples taken: prior to surgery, on reperfusion, 2, 24 and 48 h post-surgery. Platelet aggregation through COX-mediated and thrombin receptor activator peptide (TRAP)-stimulated GPIIb/IIIa pathways was measured by the Ultegra point of care system. Thrombin-antithrombin III Complex (TAT) and D-dimer were measured by ELISA. COX-mediated aggregation increased significantly at reperfusion and remained elevated at 24 h [median increase from baseline of 9% (range -16 to 33%) P = 0.011]. TRAP-stimulated aggregation increased significantly at reperfusion and remained elevated at 2 h post-surgery [median increase 18% (range -71 to 45%); P = 0.007]. TAT levels were significantly elevated from reperfusion and remained so at 48 h (P < 0.003), whereas D-dimer only increased at 24 h (P = 0.014). For the first time, we have demonstrated that in patients with SLI, platelet aggregation is increased following surgery and there is a mismatch in the balance between the coagulation and fibrinolytic pathways despite the use of aspirin and heparin. Thus in the early postoperative these patients exhibit a pro-thrombotic state.

AB - Platelet and coagulation activation are implicated in the increased incidence of ischaemic events seen in patients with peripheral arterial disease. This study aimed to assess the effect of surgical revascularisation on platelet aggregation and coagulation in patients with severe limb ischaemia (SLI). Twenty-two patients had blood samples taken: prior to surgery, on reperfusion, 2, 24 and 48 h post-surgery. Platelet aggregation through COX-mediated and thrombin receptor activator peptide (TRAP)-stimulated GPIIb/IIIa pathways was measured by the Ultegra point of care system. Thrombin-antithrombin III Complex (TAT) and D-dimer were measured by ELISA. COX-mediated aggregation increased significantly at reperfusion and remained elevated at 24 h [median increase from baseline of 9% (range -16 to 33%) P = 0.011]. TRAP-stimulated aggregation increased significantly at reperfusion and remained elevated at 2 h post-surgery [median increase 18% (range -71 to 45%); P = 0.007]. TAT levels were significantly elevated from reperfusion and remained so at 48 h (P < 0.003), whereas D-dimer only increased at 24 h (P = 0.014). For the first time, we have demonstrated that in patients with SLI, platelet aggregation is increased following surgery and there is a mismatch in the balance between the coagulation and fibrinolytic pathways despite the use of aspirin and heparin. Thus in the early postoperative these patients exhibit a pro-thrombotic state.

KW - platelet aggregation

KW - thrombin-antithrombin

KW - D-dimer

KW - surgical revascularisation

KW - peripheral arterial disease

KW - vascular surgery

KW - carotid endarterectomy

KW - myocardial infarction

KW - platelet activation

KW - P-selectin

KW - aspirin resistance

KW - coagulation

KW - heparin

KW - stress

U2 - 10.1080/09537100600746540

DO - 10.1080/09537100600746540

M3 - Article

VL - 17

SP - 311

EP - 317

JO - Platelets

JF - Platelets

SN - 0953-7104

IS - 5

ER -