Ikuma H, Wada H, Mori Y, Shimura M, Hiyoyama K, Nakasaki T, Nishikawa M, Onoda K, Yamada N, Ohta T, Nishioka J, Nobori T, Gabazza E C, Sakuragawa N, Shiku H
Second Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan.
Blood Coagul Fibrinolysis. 1999 Oct;10(7):429-34. doi: 10.1097/00001721-199910000-00005.
The objective of this study was to evaluate several molecular markers of hemostasis in 84 patients with hypercoagulable state, treated with warfarin under thrombo-test (TT) monitoring; TT was expressed as percent of control (TT%). In all patients, the average values of international normalized ratio (INR) of prothrombin time (PT;PT-INR) was 1.68+/-0.49; this increase in PT-INR was not, however, significant in patients under TT% monitoring. There were no thrombotic or severe bleeding complications in these patients during a period of 2 years. Plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (sFM) were slightly increased, suggesting that anticoagulant therapy was not completely effective in our Japanese patients based on the values of TT%. Activated partial thromboplastin time, PT-INR, TT% and protein C activity were significantly correlated with the dose of warfarin; fibrinogen, activated thromboplastin, TAT, PPIC, D-dimer, sFM, protein S and thrombomodulin were not significantly correlated with the dose of warfarin. The PT-INR was negatively correlated with TT%, protein C and protein S, and the correlation between PT-INR and TT-INR was better than that between PT-INR and TT%. The range of TT% was not correlated with the plasma levels of TAT, PPIC, D-dimer or sFM, but the range of PT-INR was correlated with the plasma level of TAT, D-dimer and sFM. The percentage of TAT, D-dimer and sFM within normal range was significantly low in patients with high PT-INR. These finding showed that PT-INR is better than TT% for monitoring the anticoagulant therapy with warfarin, and that TT should be expressed as INR. The values of PT-INR should be more than 1.7 during the anticoagulant therapy with warfarin in Japanese patients with high risk of thrombosis.
本研究的目的是评估84例处于高凝状态且在血栓弹力图（TT）监测下接受华法林治疗的患者的几种止血分子标志物；TT以对照百分比（TT%）表示。在所有患者中，凝血酶原时间（PT；PT-INR）的国际标准化比值（INR）平均值为1.68±0.49；然而，在TT%监测下的患者中，PT-INR的这种升高并不显著。在2年期间，这些患者未发生血栓形成或严重出血并发症。凝血酶 - 抗凝血酶复合物（TAT）、纤溶酶 - 纤溶酶抑制剂复合物（PPIC）、D - 二聚体和可溶性纤维蛋白单体（sFM）的血浆水平略有升高，这表明基于TT%的值，抗凝治疗在我们的日本患者中并不完全有效。活化部分凝血活酶时间、PT-INR、TT%和蛋白C活性与华法林剂量显著相关；纤维蛋白原、活化凝血活酶、TAT、PPIC、D - 二聚体、sFM、蛋白S和血栓调节蛋白与华法林剂量无显著相关。PT-INR与TT%、蛋白C和蛋白S呈负相关，且PT-INR与TT-INR之间的相关性优于PT-INR与TT%之间的相关性。TT%范围与TAT、PPIC、D - 二聚体或sFM的血浆水平无关，但PT-INR范围与TAT、D - 二聚体和sFM的血浆水平相关。PT-INR高的患者中，TAT、D - 二聚体和sFM在正常范围内的百分比显著较低。这些发现表明，在监测华法林抗凝治疗方面，PT-INR优于TT%，且TT应以INR表示。在血栓形成高风险的日本患者中，华法林抗凝治疗期间PT-INR值应大于1.7。
