A comparison of postoperative thrombotic potential following abdominal aortic surgery, carotid endarterectomy, and femoro-popliteal bypass.

Postoperative changes in procoagulant, anticoagulant, and antifibrinolytic factors were compared in patients undergoing abdominal aortic surgery, carotid endarterectomy, and femoro-popliteal bypass. There were increases in plasma fibrinogen (P < 0.01) and factor VIII coagulant (P < 0.01) levels following all three procedures. There were decreases in antithrombin III (P < 0.01) and protein C (P < 0.01), and increases in thrombin-antithrombin complex levels (P < 0.01) in the abdominal aortic group only. There were no significant changes in type 1 plasminogen activator inhibitor levels following any of the procedures. The results indicate that all three procedures are associated with an increased potential for thrombosis due to increases in procoagulant factors. However, patients undergoing abdominal aortic surgery are particularly at risk due to concurrent decreases in natural anticoagulant factors. Specific antithrombotic therapy should be considered for all patients undergoing vascular surgery, but particularly for those undergoing major procedures such as abdominal aortic surgery.