Functional and immunologic levels of antithrombin III (ATIII) and plasminogen were
assessed in three groups of nine patients each: elective surgery, moderate and severe
trauma. Patients otherwise healthy were classified as follows: I, elective extremity
surgery, no blood transfusions, normal coagulation screening tests (14-50y); II, isolated,
moderately severe trauma (e.g., replantation or revascularization of one or more digits),
no transfusions (14-56y); and III, Isolated, severe trauma to extremities, with replantation
and revascularization of a severed arm or leg, receiving 1-4 units of whole CPD blood
(20-59y). Preoperative, intraoperative (2 hr into surgery) and 24 hr postoperative
values were measured. Group III only had intraoperative sampling, with the exception
of two patients who had preoperative values prior to any transfusions. A detailed
statistical comparision was made (at the 95% confidence level) of the differences
in ATIII activity, ATIII antigen level, the ratio of ATIII activity-to-antigen and
plasminogen activity among categories within and between groups. The data suggest
that elective surgery and moderate trauma had virtually the same effect on ATIII and
plasminogen. Activity and antigen values decreased intraoperatively but on the average
not enough to be out of the acceptable range. During the convalescent period most
ATIII values returned to their preoperative level while most plasminogen values continued
to decline somewhat (although still in the acceptable range). By contrast, both ATIII
and plasminogen values in the severe trauma group were markedly depressed compared
to preoperative levels In either group I or II. Four of the patients in this group
suffered postoperative thrombosis and loss of an extremity even though the limb was
initially viable. The transient lowering of both ATIII and available plasminogen is
undoubtedly most critical when surgical stress is superimposed on existing trauma.
