The short term effects of Endovascular Aneurysm Repair (EVAR) on coagulation and cardiovascular morbidity and mortality in patients with infra-renal Abdominal Aortic Aneurysms

Davies, Robert (2012). The short term effects of Endovascular Aneurysm Repair (EVAR) on coagulation and cardiovascular morbidity and mortality in patients with infra-renal Abdominal Aortic Aneurysms. University of Birmingham. M.D.

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Abstract

OBJECTIVE: Patients undergoing open repair of asymptomatic abdominal aortic aneurysms (AAA) demonstrate a prothrombotic state that initially deteriorates in the peri-operative period before improving beyond the pre-operative state. We hypothesised that a similar haemostatic improvement occurs following endovascular AAA repair (EVAR) and that the initial prothrombotic derangement may increase the risk of myocardial injury.

METHODS: 60 patients[57 men; median(IQR) age, 77 (72-82) years] underwent EVAR. Patients were assessed at baseline, 24-hours and 1-month post-procedure. Thrombin-antithrombin III-complex (TAT), tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1), and soluble (s) P-selectin levels were assessed as biomarkers of coagulation, fibrinolysis and platelet activity, respectively. Cardiac Troponin T (cTnT) levels were assessed as a biomarker of myocardial injury (MI).

RESULTS: An increase in sP-selectin levels occurred between baseline[median(IQR), 80.5(68-128) ng/ml], 24-hours[median(IQR), 89.5(73-112)ng/ml; p=0.003] and 1-month[median(IQR), 110(89-143)ng/ml; p=<0.0001] post-EVAR. There was a trend towards increased TAT levels at 24-hours[median(IQR), 21.65(13-33.1)μg/l; p=0.069] compared to pre-operation[median(IQR), 7.15(4.7-31.3)μg/l] followed by a significant decrease at 1-month[median(IQR), 8.1 (5.4-14.85)μg/l; p=<0.0001]. cTnT levels were raised (>0.03ng/ml) in 16% of patients. There was a positive correlation between cTnT and TAT levels at 24-hours post-EVAR(r=0.38, p=0.039, Kendall-tau-B=0.26)

CONCLUSION: These novel data suggest that the peri-operative pro-thrombotic state following EVAR may be associated with an increased risk of MI.

Type of Work:

Thesis (Higher Doctorates > M.D.)

Award Type:

Higher Doctorates > M.D.

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