Coagulation changes in elective surgery and trauma.

Although antithrombin-3 (AT-3), a naturally-occurring inhibitor of thrombin, has been associated with a variety of thrombotic disorders, it has been studied in surgery and trauma. Three groups of patients were studied: Group I (20 patients) who underwent elective surgery; Group II (ten patients) who sustained moderate trauma: Group III (ten patients) who sustained severe trauma. Hypercoagulability panels were run preoperatively, intraoperatively, and postoperatively. Nine units of banked blood were also tested. The coagulation pattern changed during the stress, becoming hypercoagulable in proportion to the stress endured by the patient. In the severe trauma group, AT-3 fell significantly (p less than or equal to 0.002) in all patients, indicating extreme hypercoagulability. Three of these patients sustained thrombosis and loss of the involved extremity. The banked blood was found to be hypercoagulable. It appears that patients who sustain severe trauma, have multiple transfusions, and major operative procedures are at increased risk of developing postoperative thrombotic complications, including loss of limb.