Changes in circulating markers of coagulation and fibrinolysis after EVAR.

Introduction: The presence of an abdominal aortic aneurysm (AAA) is associated with increased thrombin formation, fibrin turnover and fibrinolysis.

Evidence Acquisition: The aim of this study was to review the relevant literature and summarize the evidence regarding the impact of endovascular repair on the circulating markers of coagulation and fibrinolysis postprocedure.

Evidence Synthesis: The main findings are that the increased thrombin activation, and formation, as well as fibrinolysis, in patients with AAA is exacerbated after endovascular repair in the short-term and the mid-term, implying that this may be a period associated with an increased likelihood for adverse cardiovascular events. It is estimated that this prothrombotic state is normalized within a year of the endovascular procedure. Furthermore, elevated levels of specific markers of fibrinolysis are associated with the presence of an endoleak during the follow-up imaging and the clinical implications of these findings merit investigation.

Conclusions: Further and larger studies are needed to explore the impact of these changes in coagulation and fibrinolysis on the outcome of endovascular repair in patients with AAA.