• D A Lubarsky, S D Fisher, T F Slaughter, C L Green, C K Lineberger, J R Astles, C S Greenberg, W W Inge, and M W Krucoff.
• Department of Anesthesiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. lubar001@mc.duke.edu
• J Clin Anesth. 2000 Mar 1; 12 (2): 136-41.

Study ObjectivesTo evaluate the relationship between perioperative ischemia and serial concentrations of D-dimer, which is a sensitive and specific marker of fibrinolytic activity. Myocardial ischemia and infarction are well-recognized complications of peripheral vascular surgery. We hypothesized that patients at increased risk of perioperative myocardial ischemia might be identified preoperatively by abnormal hemostatic indices.DesignProspective clinical outcomes study.SettingA 1,124-bed tertiary care medical center.Patients42 ASA physical status II, III, and IV patients undergoing peripheral vascular surgery.InterventionsSerial D-dimer concentrations were measured preoperatively, and at 24 and 72 hours postoperatively. Continuous 12-lead ST-segment monitoring (Mortara Instrument, Inc., Milwaukee, WI) was performed with the acquisition of a 12-lead ECG every 20 seconds for 72 hours.Measurements And Main ResultsD-dimer measurements were performed in duplicate using the Dimer Gold assay (American Diagnostica, Greenwich CT). Ischemic episodes, as defined by continuous 12-lead ST-segment monitoring, occurred in 49% of patients. There were no demographic differences between ischemic and nonischemic groups. Although baseline D-dimer concentrations were not statistically significantly different between groups, patients experiencing perioperative myocardial ischemia generated significantly less D-dimer during the perioperative period (p = 0. 014).ConclusionsPATIENTS with an impaired fibrinolytic response, as defined by reduced generation of D-dimer, experienced an increased incidence of perioperative myocardial ischemia.

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