British Journal of Anaesthesia, 2001, Vol. 87, No. 3 435-440
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Changes of haemostasis in patients undergoing major abdominal surgery—is there a difference between elderly and younger patients?
1Department of Anaesthesiology and Intensive Care Medicine and 2Clinic of Surgery, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany*Corresponding author: Department of Anaesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany
Many physiological functions are altered in the elderly. It is not clear whether this applies to haemostatic mechanisms in patients undergoing major surgery. Twenty-five consecutive patients <60 yr and 25 consecutive patients >70 yr scheduled for abdominal surgery for malignancies were included in our study. Various standard coagulation variables and specific markers of coagulation were serially measured before surgery (baseline), at arrival on the 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 Platelet Function Analyser PFA-100TM with adenosine diphosphate (ADP) as an inductor. Anaesthesia and surgery were similar between the elderly (76(3) years) and younger (53(5) years) groups. Baseline plasma levels of prothrombin fragments F1+2, thrombin-antithrombin III (TAT) complex, and D-dimers were significantly different between the two groups, indicating thrombin activation and fibrin formation in the elderly. Postoperatively, only F1+2 plasma levels were significantly higher in the elderly (4.0(0.8) nmol/l) than in 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-derived 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 with the younger patients. It is concluded that elderly patients showed more prothrombin activation/thrombin generation and increased fibrinolytic activity prior to surgery than younger patients. However, perioperative changes of coagulation in the elderly were similar to those seen in younger patients.
Br J Anaesth 2001; 87: 435–40
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