al-Momen A K, Huraib S O
Department of Medicine, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
Haemostasis. 1992;22(1):12-6. doi: 10.1159/000216286.
Four hemodialysis patients (1 male and 3 females, aged 29-40 years) with unusual recurrent vascular access or dialyzer thrombosis were studied to find out whether a hypercoagulable state exists. Measurements of euglobulin clot lysis time (ELT), fibrinogen, antithrombin III (AT III), protein C (PC), protein S (PS), tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI) were done. Results indicated that all patients had prolonged ELT, low tPA, elevated PAI, normal AT III, and PS. Three patients had elevated fibrinogen level and two had low PC. Danazol 200 mg orally once a day effectively prevented any further thrombosis. In 4 weeks' time, all the abnormal coagulation studies normalized in addition to elevation of AT III, PC and PS. Only 1 female patient had a prolonged menstrual period, which was reversed by lowering the daily dose of danazol to 100 mg. No other side effects were encountered. These data indicate that hypofibrinolysis may play a major role in vascular access or dialyzer thrombosis and that low-dose danazol may provide an effective prophylaxis and treatment. Larger controlled studies are needed to confirm these findings.
对4例（1例男性，3例女性，年龄29 - 40岁）出现异常复发性血管通路或透析器血栓形成的血液透析患者进行研究，以确定是否存在高凝状态。测定了优球蛋白凝块溶解时间（ELT）、纤维蛋白原、抗凝血酶III（AT III）、蛋白C（PC）、蛋白S（PS）、组织型纤溶酶原激活剂（tPA）和纤溶酶原激活剂抑制剂（PAI）。结果表明，所有患者的ELT均延长，tPA水平低，PAI升高，AT III和PS正常。3例患者纤维蛋白原水平升高，2例患者PC水平低。口服达那唑200 mg，每日1次，可有效预防进一步的血栓形成。在4周内，除AT III、PC和PS升高外，所有异常凝血指标均恢复正常。只有1例女性患者经期延长，将达那唑日剂量降至100 mg后经期恢复正常。未发现其他副作用。这些数据表明，纤维蛋白溶解功能低下可能在血管通路或透析器血栓形成中起主要作用，低剂量达那唑可能提供有效的预防和治疗。需要进行更大规模的对照研究来证实这些发现。
