Parízek P, Haman L, Malý J, Pecka M, Hodac M, Bukac J, Stránský P, Malý R, Duda J, Pleskot M
Lékarské fakulty UK a FN, Hradec Králové.
Vnitr Lek. 2004 Dec;50(12):887-93.
The aim of the study was to investigate chosen haemostasis activation markers during electrophysiologic study (EPS) with consequent radiofrequency catheter ablation (RFA). Sixty-three patients were studied prospectively. Indications for EPS and RFA were supraventricular tachycardias with the arrhythmogenic substrate located in the right atrium. Blood samples were drawn 24 hours before the procedure (T -1), at the beginning of the procedure (T0), at the end of EPS (T1), 30 minutes after completion of RFA (T2), and 24 hours after the procedure (T3). To study coagulation, fibrinolytic and platelet activation were measured concentrations of thrombin-antithrombin III (TAT), D-dimers (DD), platelet count and parameters, and circulating platelet aggregates (CPAi). During the EPS and RFA, TAT levels increased from the baseline 5.03 +/- 2.53 microg/l (T -1) to 12.90 +/- 12.83 microg/l at T0 (p < 0.001) to 36.07 +/- 15.59 microg/l at T1 (p < 0.001) and decreased to 28.85 +/- 13.14 microg/l at T2 (p < 0.001). Levels of DD increased from 0.30 +/- 0.20 mg/l at T0 to 0.44 +/- 0.25 mg/l at T1 (p < 0.001) and to 0.87 +/- 0.74 mg/l at T2 (p < 0.001). The number of platelets was significantly decreased (-13.7%) before and during the procedure (T -1 vs. T3; p < 0.001). Marked platelet activation (CPAi 0.62 +/- 0.32) was observed before the procedure opposite to the physiological values (CPAi 1.0 +/- 0.1), without changes during the procedure (CPAi at T2 0.69 +/- 0.23). Our results confirmed activation of several haemostasis parameters during EPS and RFA, and support eligibility of the antithrombotic prevention in patients indicated for EPS and RFA.
本研究旨在调查在电生理检查(EPS)及随后的射频导管消融术(RFA)期间选定的止血激活标志物。对63例患者进行了前瞻性研究。EPS和RFA的适应证为心律失常起源部位位于右心房的室上性心动过速。在手术前24小时(T-1)、手术开始时(T0)、EPS结束时(T1)、RFA完成后30分钟(T2)以及手术后24小时(T3)采集血样。为研究凝血、纤溶和血小板激活情况,检测了凝血酶 - 抗凝血酶III(TAT)、D - 二聚体(DD)的浓度、血小板计数及参数,以及循环血小板聚集体(CPAi)。在EPS和RFA期间,TAT水平从基线的5.03±2.53微克/升(T-1)在T0时升至12.90±12.83微克/升(p<0.001),在T1时升至36.07±15.59微克/升(p<0.001),并在T2时降至28.85±13.14微克/升(p<0.001)。DD水平从T0时的0.30±0.20毫克/升升至T1时的0.44±0.25毫克/升(p<0.001),并在T2时升至0.87±0.74毫克/升(p<0.001)。手术前及手术期间血小板数量显著减少(-13.7%)(T-1与T3比较;p<0.001)。术前观察到明显的血小板激活(CPAi 0.62±0.32),与生理值(CPAi 1.0±0.1)相反,手术期间无变化(T2时CPAi 0.69±0.23)。我们的结果证实了EPS和RFA期间多种止血参数的激活,并支持对有EPS和RFA适应证的患者进行抗血栓预防的合理性。