Summary
A previous study of neurosurgical patients demonstrated an imbalance between thrombin
and plasmin action following surgery. The present study was designed to determine
the effect of intermittent pneumatic calf compression on postoperative enzyme activity.
Fibrinopeptide A (FPA) and Bβ 1-42 levels, reflecting thrombin and plasmin action
respectively, were measured daily in patients undergoing elective craniotomy. Two
of 9 patients not receiving calf compression developed positive fibrinogen leg scans,
while none of 5 patients receiving prophylaxis had positive scans. Calf compression
was associated with a markedly altered pattern of changes in the fibrinopeptide values
following surgery. Without compression, there was perturbation of the balance between
thrombin and plasmin action on the day after surgery as reflected by an increase in
the FPA/Bβ 1-42 ratio. In contrast, in those receiving prophylaxis there was no change
in this ratio on the first postoperative day. Calf compression both blunted the mean
postoperative increase in the FPA level (1.8 nM vs 4.7 nM; p <.05) and augmented the
mean Bβ 1-42 value (3.0 nM vs 0.2 nM; p <.05) so that the mean increase in the FPA/
Bβ 1-42 ratio was only 0.1 with calf compression as compared to 2.2 without it (p
<.05). Systemic modulation of both the coagulation and fibrinolytic pathways thus
occurred in association with calf compression.
Keywords
Calf compression - Thrombin/plasmin activity
