Tripodi Armando, Martinelli Ida, Chantarangkul Veena, Battaglioli Tullia, Clerici Marigrazia, Mannucci Pier Mannuccio
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Medical Specialties, University and IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy.
Thromb Res. 2007;121(3):353-9. doi: 10.1016/j.thromres.2007.04.012. Epub 2007 Jun 8.
The risk of venous thromboembolism (VTE) is increased by an excess of procoagulant or by a defect of anticoagulant proteins, with circumstantial risk factors playing a significant contribution. These conditions are directly linked to or are compatible with increased thrombin generation. Assuming that the more thrombin is generated the higher is the risk of VTE, an overall coagulation test monitoring ex vivo thrombin generation and reflecting the interaction of pro- and anticoagulant proteins would be useful to determine the risk of VTE.
This hypothesis was tested by measuring the endogenous thrombin potential (ETP) without or with thrombomodulin (TM) in plasmas from 403 individuals stratified according to their relative risk of VTE (no, low, intermediate, or high risk) according to whether or not they had congenital and/or circumstantial risk factors. Odds ratio (OR) and 95% confidence interval (CI), taken as a measure of the relative risk of having high levels of ETP, were calculated for the different categories relatively to the no-risk category.
When the ETP was measured with TM, ORs (95% CI) were 2.10 (1.23-3.60); 4.03 (2.18-7.45) and 4.96 (2.40-10.23) for the low-, intermediate and high-risk category. When ETP was measured without TM there was no gradient of OR values as function of the risk category.
ETP measured with TM may help to distinguish individuals with different risk of VTE, however, the practical utility of measuring ETP in clinical practice remains to be evaluated in prospective studies.
促凝血蛋白过多或抗凝血蛋白缺陷会增加静脉血栓栓塞（VTE）的风险，环境危险因素也起重要作用。这些情况与凝血酶生成增加直接相关或与之相符。假设凝血酶生成越多，VTE风险越高，那么一种监测体外凝血酶生成并反映促凝血蛋白和抗凝血蛋白相互作用的全面凝血试验将有助于确定VTE风险。
通过测量403名个体血浆中有无血栓调节蛋白（TM）时的内源性凝血酶潜力（ETP）来验证这一假设，这些个体根据其VTE相对风险（无、低、中或高风险）进行分层，无论他们是否有先天性和/或环境危险因素。计算不同类别相对于无风险类别的比值比（OR）和95%置信区间（CI），作为ETP水平高的相对风险度量。
当用TM测量ETP时，低、中、高风险类别的OR（95%CI）分别为2.10（1.23 - 3.60）、4.03（2.18 - 7.45）和4.96（2.40 - 10.23）。当不用TM测量ETP时，OR值没有随风险类别呈梯度变化。
用TM测量ETP可能有助于区分VTE风险不同的个体，然而，在临床实践中测量ETP的实际效用仍有待前瞻性研究评估。
