POSTOPERATIVE CHANGES IN HEMOSTASIS, ANALYZED BY SERIAL DETERMINATION OF FIBRINOPEPTIDES AND D DIMER

It is generally believed that hypercoagulable state occurs after surgery, followed by hyperfibrinolytic state. Though a considerable number of studies on the postoperative changes in hemostasis have been reported, the results are inconclusive, as it is difficult to detect in vivo activation of coagulation and fibrinolysis by conventional laboratory tests. Thereby, attempts were made to elucidate the changes by serial determination of fibrino-peptide A (FPA), fibrinopeptide B Beta 15-42 (BB) & D dimer in our surgical cases ([A]-27 hepatic resections, [B]-27 gastric resections, [C]-4 probe laparotomies). FPA & BB were determined by radioimmunoassay and D dimer was assayed by aggulutination of Latex beads coated with monoclonal antibody. FPA was elevated lh after surgery in [A](25.5± 7.6ng/ml) and [B](16.4± 3.3) and it returned to normal range (4.2± 2.1) by postoperative day 1 (POD 1). No such change was noted in [C]. BB in [A] was elevated (46.2± 10.6ng/ml) lh after surgery and the value remained high until POD 14. In [B], BB was likewise elevated at lh (50.9± 7.7) and it gradually decreased to 26.0± 4.8 by POD 2. Then, it again increased to 36.8± 5.1 and remained high until POD 10. The value in [C] was normal (6.8± 2.4) throughout the period. FDP was moderately increased (10-20ug/ml) until POD 14 & 7 in [A] & [B]. Regardless of the increased level of BB, the amount of D dimer was within normal range (<200ng/ml) until POD 1 & 3 in [A] & [B]. Thereafter, it gradually increased and reached above l,000ng/ml between POD 7 and 10 in both groups. From these observations, the following conclusions were obtained; (1) Unexpectedly, postoperative hypercoagulable state was transient and of low magnitude. (2) On the other hand, significant fibrinolysis was observed immediately after surgery and it continued over 10 days. The early phase (up to POD 3) is likely to be primary fibrinolysis as it was not accompanied by formation of D dimer. The late phase is considered to be secondary fibrinolysis as D dimer was also elevated. (3) Regardless of the different surgical procedures, these changes were basically similar between [A] and [B], though the intensity of the changes was different. Therefore, the postoperative changes in hemostasis presented herein may be the general physiological responce against at least abdominal surgery.