Activation of coagulation and fibrinolysis during reconstructive microsurgery in patients with cancer

Cancer patients are subjected to increased systemic risk of thrombotic even ts and may therefore be at higher risk of even local thrombosis compromisin g the outcome of reconstructive microsurgery. Coagulation and fibrinolysis activities were studied serially during and after reconstructive microsurge ry in seven patients with oropharyngeal cancer or sarcoma in the extremitie s. A preoperative hypercoagulable state was found in four patients (elevate d fibrinogen, TAT, F1+2, or D-dimer), two of these patients also had a loca l thrombotic, event. In all patients, the plasma markers generally varied p erioperatively: fibrinogen decreased, whereas TAT and subsequently D-dimer increased at the end of the operation. However, tPA and PAI-1 remained unal tered, except in the patients with thrombosis in whom PAI-1 activity increa sed progressively during the operation. F1+2 was also clearly elevated in t hese two patients at the time of thrombosis. Preoperative assessment of hyp ercoagutability for this group of patients could be helpful in targeting me ticulous antithrombotic protection. (C) 2001 Wiley Liss, Inc.