Blood Goagulation and Fibrinolytic Activity in Emergency Surgery

Akira Usuba, Gohichi Endoh, Mitsunori Takahara, Kazuhito Matayoshi, Akio Ohishi, Yukio Endoh, Hitoshi Inoue, Ryoichi Motoki

First Department of Surgery, Fukushima Medical College

The aim of this study was to evaluate hypercoagulability to establish measures to prevent postoperative complications such as multiple organ failure and disseminated intravascular coagulation. The subjects were 21 patients with diseases of he digestive tract, 12 undergoing emergency surgery because of diffuse peritonitis and 9 undergoing emergency surgery because of massive hemorrhage. In the peritonitis group, thrombin activity was increased but platlet generation and fibrinolysis were within the normal range before surgery. Immediately after surgery, all three activities increased although they returned to normal withiin a week except for patients with multiple organ failure. Fibrinopeptide A, fibrinogen and antithrombin III levels reflected the clinical course most accurately. In the hemorrhage group, thrombin activity, platelet generation and fibrinogen were increased before surgery. There was a close correlation between hemorrhage on the one hand and the rate of decrease in platelet count and prothrombin time on the other. Multiple organ failure developed in most of the patients in the postoperative course, and recovery was delayed. Platelet count and prothrombin time reflected the clinical course most accurately. We conclude that hypercoagulability emerges before surgery and that it is closely related to postoperative complications.

Key words
emergency surgery, blood coagulation, fibrinolytic activity, hypercoagulable state

Reprint requests
Akira Usuba First Department of Surgery, Fukushima Medical College 1 Hikarigaoka, Fukushima, 960-12 JAPAN

Accepted
May 9, 1990

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