Summaria L, Caprini JA, McMillan R, Sandesara J,
Axelrod CA, Mueller ME, Vagher JP, Walenga J, Fareed J.
Relationship between postsurgical fibrinolytic parameters and deep vein
thrombosis in surgical patients treated with compression devices.
Am Surg 1988 Mar;54(3):156-60

Department of Surgery, Evanston Hospital, Illinois 60201.
This study consisted of 52 patients admitted for orthopedic surgery and 28
patients admitted for general surgery, who were treated with Sequential
Compression Devices (SCD) and Thromboembolic Deterrent Stockings (TEDS) and
monitored for the development of deep vein thrombosis (DVT). Coagulation and
fibrinolytic profiles were carried out on these patients preoperatively, and on
days one, three, and six postoperatively. All patients were followed by
I-125-Fibrinogen scanning, Venous Doppler, and Impedance Plethysmography studies
for clot detection. In the orthopedic surgery group, six (11.5%) developed DVT,
and in the general surgery group, one (3.6%) developed DVT. No patients developed
pulmonary embolism. The combined incidence of DVT was 8.8 per cent. A variety of
parameters was measured in order to determine whether compression devices prevent
a fibrinolytic shut-down commonly seen in the postsurgical patient. A combination
of three assays was found to be significant in demonstrating a fibrinolytic
response. These parameters were a post-surgical decrease in the plasminogen
level, an increase in the level of free protease activity postoperatively, and an
increase in the level of tissue plasminogen activator after surgery. 56.3 per
cent of all patients treated with SCD and TEDS showed a fibrinolytic response on
postoperative day one by a combination of all three of these parameters. In the
group of patients that developed DVT none showed an increase in free protease
activity, and five of seven showed no significant decrease in plasminogen and no
increase in tissue plasminogen activator. Patients who developed thrombosis had
measurable differences in their fibrinolytic system compared to those without
postoperative thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)