Fibrinopeptide A and fibrinogenfragment B β 15–42 and their relation to the operative trauma and post-operative thromboembolism in neurosurgical patients

Summary

In an earlier study on post-operative thromboembolism in neurosurgery the incidence of deep vein thromboses (DVT) diagnosed by the fibrinogen uptake test and phlebography was reduced to the same extent by two different prophylactic methods (low dose heparin or calf muscle stimulation + dextran). However, patients with lower limb paresis due to a brain lesion experienced relatively often a less successful prophylaxis compared to patients with spinal lesions. There are few reports on successful clinical methods for haematological screening of post-operative DVT. The aim of this study was to examine possible haematological indicators for postoperative thromboembolism and secondarily to elucidate whether there exist some special coagulatory or fibrinolytic characteristics in patients who had been operated upon for brain lesions.

We have studied two specific coagulatory factors (FPA reflecting thrombin generation and Bβ 15–42 reflecting plasmin activity) in connection with neurosurgical operations. Patients in the above-mentioned study on post-operative DVT operated upon for malignant cerebral tumours or intracranial vascular disease exhibited postoperatively higher values for FPA compared to other neurosurgical diagnoses. B β 15–42 was higher in the malignant tumour group and almost significantly higher in the intracranial vascular group (p<0.065). These differences could not be ascribed to the occurrence of DVT.

Another 15 patients divided into a minor and a major lesion group were investigated with determination of both parameters pre- and post-operatively. Concerning FPA an increase was noticed post-operatively compared to pre-operatively in the major lesion group. B β 15–42 was higher post-operatively in this group compared to the minor lesion group. The results indicate a hyperactivity of the coagulatory system in patients with surgically treated brain parenchyma lesions. These patients are prone to develop post-operative DVT.