Thrombin activatable fibrinolysis inhibitor (TAFI) in stable angina pectoris patients undergoing coronary artery bypass grafting (CABG).

PURPOSE: Thrombin activatable fibrinolysis inhibitor (TAFI) seems to be a potential haemostatic risk factor of coronary artery disease (CAD). Taking into account interactions between TAFI and haemostasis, especially during cardiopulmonary bypass, we decided to determine concentration of TAFI and activated TAFI (TAFIa) and other haemostasis markers in CABG patients. MATERIAL AND METHODS: 45 CAD patients (11 women, 34 men) undergoing elective CABG were included in the study. Blood samples were taken before the operation, on the 3rd, 7th day and 3 months after CABG. A value of p<0.05 was considered statistically significant. RESULTS: We found a significant decrease in TAFIa concentration on 3rd postoperative day: 6 microg/ml (0.3-43.2) vs 8.9 microg/ml (0.5-37) before CABG (p<0.05), a significant increase in TAFI concentration on the 7th postoperative day: 127.7% +/- 36.8 vs 112.18% +/- 30.34 of standard plasma concentration before CABG (p<0.05), significant increase in plasmin-antyplasmin (PAP) complexes concentration on 3rd and 7th day, respectively: 645 microg/l (323-1237) vs 406 microg/l (197-1840) before CABG (p<0.001); and 1030 microg/l (640-2149) vs 406 microg/l (197-1840) before CABG (p<0.0001). Before operation we found a significant negative correlation between PAP complexes concentration before CABG and EuroSCORE risk scale value (p<0.01). CONCLUSIONS: In CABG patients, there is a significant increase in fibrinolytic activity due to decrease in TAFIa concentration, with simultaneous increase in PAP complexes. A significant negative correlation between PAP complexes concentration before CABG and EuroSCORE risk scale value stressed a potentially higher operation risk in patients with lower fibrinolytic activity.

[Late results of surgical and conservative treatment for atheromatous ischemia of the lower limb in young patients]. / Odlegle wyniki leczenia operacyjnego i zachowawczego miazdzycowego niedokrwienia konczyn dolnych u mlodych chorych.

The study was carried out within a multicenter program. Hundred fifty four patients under 40 years were treated (73 conservatively, and 81 surgically) for the atheromatous ischemia of the lower limbs in 14 Departments of Vascular Surgery in Poland within 5 years. The results of the treatment were evaluated according to the site of atheromatous lesions, type of surgery, and mainly according to the progress in pathologic process expressed by the degree of limb ischemia. It was found that surgery performed in the II period of the disease produces the best results. Surgery produces positively better results than conservative treatment in patients with the II period of the disease whereas both surgical and conservative therapy are ineffective in the III and IV degrees of ischemia. Sympathectomy may be effective in the occlusion of crural arteries even of the IV degree ischemia. In case of the II degree ischemia better results are produced by the operation of aorto-iliaco-femoral segment (transplantation or thrombendarterectomy) than that involving distal segment (sympathectomy) whereas the results of conservative therapy are better in peripheral and iliaco-femoral occlusion than those in aortofemoral and multisegmental arterial occlusion. An opinion of several authors on the specificity of atheromatous ischemia of the lower limbs in young patients was not confirmed.