Abstract | BACKGROUND: The purpose of this clinical trial was to compare the effects of different anesthetic and analgesic regimens on hemostatic function and postoperative arterial thrombotic complications. METHODS: RESULTS: Preoperative fibrinogen levels were similar in both groups, remained unchanged after 24 h, and increased equally (45%) in the first 72 h postoperatively. PAI-1 levels in the GA group increased from 13.6 +/- 2.1 activity units (AU)/ml to 20.2 +/- 2.6 AU/ml at 24 h and returned to baseline at 72 h. In contrast, PAI-1 levels in the RA group remained unchanged over time. Twenty-two of 95 patients (23%) had postoperative arterial thrombosis, 17 of whom had received GA and 5 of whom, RA. Preoperative PAI-1 levels were higher in patients who developed postoperative arterial thrombosis (20.5 +/- 3.6 AU/ml vs. 11.2 +/- 1.4 AU/ml). Multiple logistic regression analysis indicated that GA and preoperative PAI-1 levels were predictive of postoperative arterial thrombotic complications. CONCLUSIONS: Impaired fibrinolysis may be related causally to postoperative arterial thrombosis. Because RA combined with epidural fentanyl analgesia appears to prevent postoperative inhibition of fibrinolysis, this form of perioperative management may decrease the risk of arterial thrombotic complications in patients undergoing lower extremity revascularization.
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Authors | B A Rosenfeld, C Beattie, R Christopherson, E J Norris, S M Frank, M J Breslow, P Rock, S D Parker, S O Gottlieb, B A Perler |
Journal | Anesthesiology
(Anesthesiology)
Vol. 79
Issue 3
Pg. 435-43
(Sep 1993)
ISSN: 0003-3022 [Print] United States |
PMID | 8363067
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
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Topics |
- Aged
- Anesthesia, Epidural
- Anesthesia, General
- Arterial Occlusive Diseases
(etiology)
- Female
- Fentanyl
(administration & dosage)
- Fibrinolysis
(physiology)
- Humans
- Injections, Epidural
- Injections, Intravenous
- Leg
(blood supply)
- Male
- Morphine
(administration & dosage)
- Postoperative Complications
- Thrombosis
(etiology)
- Vascular Surgical Procedures
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