Changes of haemostasis. in patients undergoing major abdominal surgery - is there a difference between elderly and younger patients?

Many physiological functions are altered in the elderly. It is not clear wh ether this applies to haemostatic mechanisms in patients undergoing major s urgery. Twenty-five consecutive patients <60 yr and 25 consecutive patients >70 yr scheduled for abdominal surgery for malignancies were included in o ur study. Various standard coagulation variables and specific markers of co agulation were serially measured before surgery (baseline), at arrival on t he intensive care unit (ICU), 4 h after arrival on ICU, and on the morning of the first postoperative day. Platelet function was assessed using the Pl atelet Function Analyser PFA-100 \ with adenosine diphosphate (ADP) as an i nductor. Anaesthesia and surgery were similar between the elderly (76(3) ye ars) and younger (53(5) years) groups. Baseline plasma levels of prothrombi n fragments F1+2, thrombin-antithrombin III (TAT) complex, and D-dimers. we re significantly different between the two groups, indicating thrombin acti vation and fibrin formation in the elderly. Postoperatively, only F1+2 plas ma levels were significantly higher in the elderly (4.0(0.8) nmol/l) than i n the younger patients (2.2(0.9) nmol/l), whereas the course of D-dimer and TAT did not differ significantly between the two groups. Endothelial-deriv ed markers of coagulation (Von Willebrand factor, collagen-binding activity of von Willebrand factor) were not different between the groups throughout the study period. Platelet function was impaired in the elderly compared w ith the younger patients. It is concluded that elderly patients showed more prothrombin activation/thrombin generation and increased fibrinolytic acti vity prior to surgery than younger patients. However, perioperative changes of coagulation in the elderly were similar to those seen in younger patien ts.