Borries M, Heins M, Fischer Y, Stiegler H, Peters A, Reinauer H, Schoebel F C, Strauer B E, Leschke M
Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität, Düsseldorf, Deutschland.
J Am Coll Cardiol. 1999 Aug;34(2):486-93. doi: 10.1016/s0735-1097(99)00229-6.
This study investigated parameters of endogenous fibrinolysis, activation of coagulation and platelets, and endothelin levels before and after elective percutaneous transluminal coronary angioplasty (PTCA) in patients with stable coronary artery disease (CAD).
Abrupt vessel closure is a serious short-term complication after PTCA and is often unforeseeable. Detailed insight into the effect of PTCA on hemostasis, platelets and the release of vasoconstrictive substances, which are among the mainly discussed mechanisms of abrupt vessel closure, is needed to enhance the safety of coronary intervention.
Plasma levels of markers of platelet activity, coagulation, endogenous fibrinolysis and endothelins were determined in 20 patients with stable CAD undergoing elective PTCA. The blood specimens were drawn before, immediately after, 1 h after intervention and on the next morning.
All patients showed an initially uncomplicated PTCA. Regarding the efficacy of anticoagulation after receiving 15.000 IU heparin during PTCA, two groups were compared. In eight patients with ineffective anticoagulation production of thrombin and platelet activation directly after and 1 h after PTCA was significantly higher compared with 12 patients with effective anticoagulation. Despite the strong activation of coagulation, only a low fibrinolytic response could be observed. Endothelins rose significantly after PTCA in both groups but stayed longer on higher levels in patients with distinct thrombin generation. Three of the eight patients without sufficient heparin treatment suffered abrupt vessel closure.
Initially uncomplicated dilation of coronary arteries leads to systemically measurable activation of coagulation and platelets in patients with ineffective doses of heparin and release of endothelins in all patients. Therefore, individual adjustment of anticoagulation and platelet inhibition in combination with effective antivasospastic substances are needed in every patient before, during and after initially uncomplicated PTCA to prevent this serious complication.
本研究调查了稳定型冠状动脉疾病（CAD）患者在择期经皮腔内冠状动脉血管成形术（PTCA）前后内源性纤溶、凝血和血小板激活参数以及内皮素水平。
血管突然闭塞是PTCA术后严重的短期并发症，且往往不可预见。需要深入了解PTCA对止血、血小板以及血管收缩物质释放的影响，这些是血管突然闭塞主要讨论机制的一部分，以提高冠状动脉介入治疗的安全性。
对20例接受择期PTCA的稳定型CAD患者测定血浆中血小板活性、凝血、内源性纤溶和内皮素标志物水平。在干预前、干预后即刻、干预后1小时及次日早晨采集血标本。
所有患者最初的PTCA均无并发症。就PTCA期间接受15000 IU肝素后抗凝效果而言，比较了两组。与12例抗凝有效的患者相比，8例抗凝无效的患者在PTCA后即刻及1小时后凝血酶生成和血小板激活明显更高。尽管凝血强烈激活，但仅观察到低纤溶反应。两组患者PTCA后内皮素均显著升高，但凝血酶生成明显的患者内皮素在较高水平持续时间更长。8例肝素治疗不足的患者中有3例发生血管突然闭塞。
最初无并发症的冠状动脉扩张导致肝素剂量无效患者体内凝血和血小板系统可测量的激活，以及所有患者内皮素的释放。因此，在最初无并发症的PTCA术前、术中和术后，每位患者都需要个体化调整抗凝和血小板抑制，并联合有效的抗血管痉挛物质，以预防这种严重并发症。
