Postoperative changes in coagulation and fibrinolysis independent of neurogenic stimuli and adrenal hormones

Postoperative changes in various haemostatic parameters (capillary bleeding time, platelet count, fibrinogen, fibrinmonomers, prothrombin, antithrombin III, factor VIII procoagulant, factor VIII antigen, euglobulin clot lysis time, streptokinase lysis time, fibrinogen related antigens, α1−antitrypsin and α2−macroglobulin) plasma glucose and cortisol were studied in 12 female patients undergoing elective abdominal hysterectomy during either general anaesthesia or epidural analgesia (T4−S5). General anaesthesia and epidural analgesia on their own had only negligible influence on haemostatic parameters. Hysterectomy during general anaesthesia caused activation of coagulation and fibrinolysis, followed by depression of fibrinolysis. Epidural analgesia prevented the cortisol and glucose response to surgery, but did not influence the coagulation and fibrinolytic response to surgery, except for an inhibition of the postoperative increase in factor VIII antigen. It is concluded that postoperative changes in the coagulation and fibrinolytic systems are mediated by factors other than neurogenic stimuli and adrenal hormones.