Altered preoperative coagulation and fibrinolysis are associated with myocardial injury after non-cardiac surgery

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Myocardial injury after non-cardiac surgery (MINS), a complication with unclear pathogenesis, occurs within the first 30 days after surgery and worsens prognosis. Hypercoagulability induced by surgery might contribute to plaque rupture, with subsequent thrombosis and myocardial injury. This study assessed haemostatic markers before surgery and evaluated their association with MINS.<strong>Methods.</strong> This is a substudy of VISION, a prospective cohort study of perioperative cardiovascular events. Of 475 consecutive vascular surgery patients, 47 (9.9%) developed MINS, defined as postoperative high-sensitivity troponin  ≥50 ng litre⁻¹, with ≥20% elevation from the preoperative concentration. The control group consisted of 84 non-MINS patients matched for patient characteristics and co-morbidities. The following preoperative markers of hypercoagulability and fibrinolysis were measured: antithrombin, factor VIII activity, von Willebrand factor concentration and activity, fibrinogen, D-dimer, plasmin–antiplasmin complex, and tissue plasminogen activator. Moreover, C-reactive protein and CD40L concentrations were measured to assess inflammatory activity.<strong>Results.</strong> Patients with MINS compared with the non-MINS group had a significantly higher concentration of factor VIII (186 <span style="font-style:italic;">vs</span> 155%, <span style="font-style:italic;">P</span>=0.006), von Willebrand factor activity (223 <span style="font-style:italic;">vs</span> 160%, <span style="font-style:italic;">P</span><0.001), von Willebrand factor concentration (317 <span style="font-style:italic;">vs</span> 237%, <span style="font-style:italic;">P</span>=0.02), concentrations of fibrinogen (5.6 <span style="font-style:italic;">vs</span> 4.2 g litre⁻¹, <span style="font-style:italic;">P</span>=0.03), D-dimer (1680.0 <span style="font-style:italic;">vs</span> 1090.0 ng ml⁻¹, <span style="font-style:italic;">P</span>=0.04), plasmin–antiplasmin complex (747 <span style="font-style:italic;">vs</span> 512 ng ml⁻¹, <span style="font-style:italic;">P</span>=0.002) and C-reactive protein (10 <span style="font-style:italic;">vs</span> 4.5 mg litre⁻¹, <span style="font-style:italic;">P</span>=0.02) but not antithrombin (95 <span style="font-style:italic;">vs</span> 94%, <span style="font-style:italic;">P</span>=0.89), tissue plasminogen activator (11 <span style="font-style:italic;">vs</span> 9.7 ng ml⁻¹, <span style="font-style:italic;">P</span>=0.06) and CD40L (8790 <span style="font-style:italic;">vs</span> 8580 pg ml⁻¹, <span style="font-style:italic;">P</span>=0.73).<strong>Conclusions.</strong> Preoperative elevation of blood markers of hypercoagulability in patients undergoing vascular surgery is associated with a higher risk of MINS.<strong>Clinical trial registration.</strong> NCT00512109.</span>

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