Rajagopalan S, Ford I, Bachoo P, Hillis G S, Croal B, Greaves M, Brittenden J
Vascular Unit, Aberdeen Royal Infirmary, Aberdeen, UK.
J Thromb Haemost. 2007 Oct;5(10):2028-35. doi: 10.1111/j.1538-7836.2007.02694.x. Epub 2007 Jul 23.
Myocardial ischemia is the leading cause of postoperative mortality and morbidity in patients undergoing major vascular surgery. Platelets have been implicated in the pathogenesis of acute thrombotic events. We hypothesized that platelet activity is increased following major vascular surgery and that this may predispose patients to myocardial ischemia.
Platelet function in 136 patients undergoing elective surgery for subcritical limb ischemia or infrarenal abdominal aortic aneurysm repair was assessed by P-selectin expression and fibrinogen binding with and without adenosine diphosphate (ADP) stimulation, and aggregation mediated by thrombin receptor-activating peptide and arachidonic acid (AA). Cardiac troponin-I (cTnI) was performed.
P-selectin expression increased from days 1 to 3 after surgery [median increase from baseline on day 3: 53% (range: -28% to 212%, P < 0.01) for unstimulated and 12% (range: -9% to 45%, P < 0.01) for stimulated]. Fibrinogen binding increased in the immediate postoperative period [median increase from baseline: 34% (range: -46% to 155%, P < 0.05)] and decreased on postoperative day 3 (P < 0.05). ADP-stimulated fibrinogen binding increased on day1 (P < 0.05) and thereafter decreased. Platelet aggregation increased on days 1-5 (P < 0.05). Twenty-eight (21%) patients had a postoperative elevation (> 0.1 ng mL(-1)) of cTnI. They had significantly increased AA-stimulated platelet aggregation in the immediate postoperative period and on day 2 (P < 0.05), and non-response to aspirin (48% vs. 26%, P = 0.036).
This study has shown increased platelet activity and the existence of non-response to aspirin following major vascular surgery. Patients with elevated postoperative cTnI had significantly increased AA-mediated platelet aggregation and a higher incidence of non-response to aspirin compared with patients who did not.
心肌缺血是接受大血管手术患者术后死亡和发病的主要原因。血小板与急性血栓形成事件的发病机制有关。我们假设大血管手术后血小板活性增加，这可能使患者易患心肌缺血。
通过P-选择素表达、有无二磷酸腺苷（ADP）刺激时的纤维蛋白原结合以及凝血酶受体激活肽和花生四烯酸（AA）介导的聚集，评估136例因临界性肢体缺血或肾下腹主动脉瘤修复而接受择期手术患者的血小板功能。检测心肌肌钙蛋白I（cTnI）。
术后第1天至第3天，P-选择素表达增加[第3天相对于基线的中位数增加：未刺激时为53%（范围：-28%至212%，P<0.01），刺激时为12%（范围：-9%至45%，P<0.01）]。术后即刻纤维蛋白原结合增加[相对于基线的中位数增加：34%（范围：-46%至155%，P<0.05）]，术后第3天下降（P<0.05）。ADP刺激的纤维蛋白原结合在第1天增加（P<0.05），此后下降。血小板聚集在第1至5天增加（P<0.05）。28例（21%）患者术后cTnI升高（>0.1 ng/mL）。他们在术后即刻和第2天AA刺激的血小板聚集显著增加（P<0.05），对阿司匹林无反应（48%对26%，P=0.036）。
本研究表明大血管手术后血小板活性增加且存在对阿司匹林无反应的情况。与未出现这种情况的患者相比，术后cTnI升高的患者AA介导的血小板聚集显著增加且对阿司匹林无反应的发生率更高。
