Sequential changes in coagulation and platelet function following femorotibial bypass

Twenty-four patients who received no antiplatelet medications and underwent femorotibial bypass grafting (nine vein, 12 polytetrafluoroethylene [PTFE], and three composite PTFE-vein) had serial measurements taken of their platelet function and coagulation. The concentration of collagen required to produce half-maximal platelet aggregation (Kd), the platelet aggregation ratio, antithrombin III, factor VIII-related antigen, and fibrinolytic activity (platelet-rich plasma) was measured preoperatively and 3 and 7 days after surgery. Before surgery eight patients exhibited an increase of platelet reactivity to collagen. Following femorotibial bypass grafting, the mean preoperative Kd of 0.52 ± 0.37 μg/ml fell to 0.34 ± 0.35 μg/ml on the third postoperative day (P < 0.001) and returned to 0.41 ± 0.72 μg/ml on day 7. Factor VIII-related antigen increased from a mean preoperative value of 248 ± 29% of normal activity to a mean of 360 ± 96% on postoperative day 3 (p < 0.01) and further increased to 428 ± 78% on day 7 (p < 0.01). Fourteen patients had antithrombin III measurements taken, and their levels also fell on the third postoperative day (110 ± 5.7% to 71 ± 6.5%; p < 0.001). No significant changes in fibrinolytic activity were noted. Persistent platelet reactivity was found in seven patients beyond the seventh postoperative day. After administration of 325 mg of aspirin, the abnormal platelet reactivity ceased. Increased platelet reactivity to collagen, factor VIII - related antigen, and a decrease in the antithrombin III level are indicative of a hypercoagulable state in these patients. Close monitoring of hematologic function and pre- and postoperative modification of any abnormalities by pharmacologic means are needed to ensure graft patency.