Defective fibrinolysis: A risk factor in early femoropopliteal graft thrombosis

Resting plasma fibrinolytic activity and fibrinolytic activity after stimulation by 10 min of venous occlusion (fibrinolytic potential) were estimated in 51 patients before femoropopliteal reconstructive surgery. Twelve patients suffered a graft thrombosis in the first month. Resting plasma fibrinolytic activity was similar in patients with thrombosed grafts and those with functioning grafts. However reduced fibrinolytic potential was found to be a risk factor for graft thrombosis in the month after surgery (P = 0·01). Other risk factors were increasing age (P = 0·007) and the indication for surgery (P = 0·03). Thirty-four patients whose grafts were functioning after 1 month were followed up for a mean of 9 months. A further eight grafts thrombosed. Neither fibrinolytic activity nor fibrinolytic potential were found to be risk factors for late graft thrombosis. Fibrinolytic potential has been shown to be an independent risk factor for early graft thrombosis. Peri-operative fibrinolytic stimulation might be a method of improving femoropopliteal graft patency.