HYPERCOAGULABLE ABNORMALITIES AND POSTOPERATIVE FAILURE OF ARTERIAL RECONSTRUCTION

Objectives: To determine whether preoperative hypercoagulable abnormal ities are independent risk-factors for the failure of arterial reconst ruction in leg ischaemia. Methods: Sixty consecutive patients were stu died before, and for 1 year following, elective peripheral revasculari sation. Antithrombin III, protein C and protein S levels, and tests fo r lupus anticoagulant were performed preoperatively, and then repeated on the first and third postoperative days and after 1 and 6 months. H eparin-associated thrombocytopenia was also investigate if there was a postoperative fall in platelet count greater than 100 x 10(9)/l. Resu lts: Forty-six (77%) procedures were performed for critical ischaemia and 15 (25%) involved infrapopliteal reconstruction. The nature of sur gery or accepted risk factors for occlusion were comparable between th e 40 (67%) patients with patent reconstructions at 1 year and the 20 ( 33%) who had suffered failure. Preoperative hypercoagulable abnormalit ies were detected in 21 (35%) patients, with a three times greater inc idence in those whose reconstructions failed (65% vs. 20%, p<0.01), an d in 11 and 12 patients suffering early (within 1 month) occlusion. Th e lupus anticoagulant was more frequently detected when prosthetic gra fts were already present (p<0.05) and carried a positive predictive va lue for reocclusion of 67% (p<0.01). All three postoperative deaths oc curred in patients with low protein S levels before surgery. Conclusio ns: Hypercoagulable abnormalities are common prior to arterial revascu larisation and are independently associated with subsequent failure.