Saito Y, Wada H, Yamamuro M, Inoue A, Shimura M, Hiyoyama K, Gabazza E C, Isaka N, Shiku H, Takeya H, Suzuki K, Kumeda K, Kato H, Nakano T
First Department of Internal Medicine, Mie University School of Medicine, Tsu-city, Mie-ken, Japan.
Am J Hematol. 1999 Aug;61(4):238-42. doi: 10.1002/(sici)1096-8652(199908)61:4<238::aid-ajh3>3.0.co;2-8.
Changes of hemostatic parameters during percutaneous transluminal coronary angioplasty (PTCA) in 75 patients with chronic coronary artery disease were evaluated. Plasma levels of D-dimer, soluble fibrin monomer, plasmin-alpha2 antiplasmin inhibitor complex, and tissue factor (TF) were significantly increased in all patients with chronic coronary artery disease. The activity of antithrombin and protein C and the levels of protein C antigen were significantly decreased 1 hr after PTCA, but they returned to normal range 1 day after PTCA. There was no significant difference in the level of plasma APC-PCI complex before and 1 hr after PTCA. The plasma levels of D-dimer, soluble fibrin monomer, thrombomodulin, TF and PPIC were significantly decreased 1 hr, and the plasma levels of plasmin-alpha2 antiplasmin inhibitor complex 1 day after PTCA. These findings suggest that the decrease of protein C and antithrombin resulted in activation of the coagulation system. One hour after PTCA, the plasma levels of (total-free) TF pathway inhibitor (TFPI) were significantly decreased, but the plasma levels of total and free-TFPI were significantly increased, suggesting that consumption of (total-free) TFPI occurs during PTCA. Overall, these findings suggest that the hypercoagulable state improves during PTCA and that transient decrease of antithrombin, protein C, (total-free) TFPI or plasmin-alpha2 antiplasmin inhibitor complex may cause restenosis of coronary artery.
对75例慢性冠状动脉疾病患者经皮腔内冠状动脉成形术（PTCA）期间的止血参数变化进行了评估。所有慢性冠状动脉疾病患者的血浆D-二聚体、可溶性纤维蛋白单体、纤溶酶-α2抗纤溶酶抑制剂复合物和组织因子（TF）水平均显著升高。PTCA后1小时，抗凝血酶和蛋白C的活性以及蛋白C抗原水平显著降低，但PTCA后1天恢复到正常范围。PTCA前和PTCA后1小时血浆活化蛋白C-蛋白酶连接抑制物复合物（APC-PCI）水平无显著差异。PTCA后1小时，血浆D-二聚体、可溶性纤维蛋白单体、血栓调节蛋白、TF和纤溶酶原激活物抑制物-纤溶酶复合物（PPIC）水平显著降低，PTCA后1天血浆纤溶酶-α2抗纤溶酶抑制剂复合物水平显著降低。这些发现表明蛋白C和抗凝血酶的减少导致了凝血系统的激活。PTCA后1小时，（总-游离）组织因子途径抑制物（TFPI）的血浆水平显著降低，但总TFPI和游离TFPI的血浆水平显著升高，提示PTCA期间发生了（总-游离）TFPI的消耗。总体而言，这些发现表明PTCA期间高凝状态有所改善，抗凝血酶、蛋白C、（总-游离）TFPI或纤溶酶-α2抗纤溶酶抑制剂复合物的短暂降低可能导致冠状动脉再狭窄。
