Intravascular Coagulation and Fibrinolysis within Primate Extremities During Tourniquet Ischemia

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Abstract
A common although infrequently recognized complication associated with the use of a pneumatic tourniquet is profuse bleeding from the wound after deflation of the tourniquet. Whether intravascular coagulation and fibronolysis could be induced in subhuman primates [monkey] by tournique ischemia, and whether this phenomenon could be altered by pretreatment of the animal with heparin were studied. After 2 1/2 h of tourniquet ischemia, (400 mmHg) to 1 lower limb, fibrinogen levels (P < 0.005), antithrombin III levels (P < 0.05), and plasminogen levels (P < 0.05) were significantly lower, fibrin split products (P < 0.025) and fibrinopeptide A levels (P < 0.02) were significantly than values measured simultaneously in the control limbs. After pre-treatment with sodium heparin, 30 units/kg, there was no change in antithrombin III levels or fibrinogen levels, but fibrin split products in the experimental limbs were significantly elevated (P < 0.05) when compared to control limbs. In both groups the abnormal levels returned to control levels 5-30 min after tourniquet deflation. Apparently intravascular coagulation and fibrinolysis develop within ischemic subhuman primate limbs during tourniquet ischemia. Pretreatment with heparin prevents the consumption of fibrinogen and antithrombin III but does not prevent the increase in fibrin split products which was observed. Apparently intravascular coagulation and fibrinolysis contribute to post tourniquet bleeding.

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