Department of Internal Medicine, Nantes University-Hospital Centre, Nantes, France.
Clin Appl Thromb Hemost. 2009 Dec;15(6):666-75. doi: 10.1177/1076029608321436. Epub 2008 Sep 15.
There is lack of data about the correlation between hemostatic markers and the clinical and biological risk factors (RFs) for venous thromboembolism (VTE) in medical inpatients without suspicion of acute VTE.
To evaluate the coagulation activation status in patients with current known RFs for VTE, the authors measured 2 markers of hypercoagulability, thrombin antithrombin (TAT) complexes and D-dimers, at day 1 in 165 patients hospitalized in internal medicine wards without suspected acute VTE. All known RFs for VTE were systematically assessed at admission and classified in a chronological way as permanent or transient.
Surprisingly, TAT values followed a multimodal distribution. D-dimers showed a normal distribution after a logarithmic transformation (P = .34, Shapiro-Wilk test). Interestingly, a significant progression in D-dimer levels was found according to the chronological classification of RFs. D-dimer variations on multivariate analysis (not applicable for TAT because of the multimodal distribution) correlated independently with a recent inability to walk and an increase in C reactive protein level more than 10 mg/L.
(a) this study is the first to describe the variations of hypercoagulability markers according to a systematic screening of RFs for VTE in inpatients without suspicion of acute VTE, (b) TAT appeared as a less relevant marker of hypercoagulability than D-dimers in internal medicine inpatients, (d) the chronological classification of RFs identified clearly groups at risk for the prethrombotic state, and (d) an increased hypercoagulability state was demonstrated in patients with an association between a recent immobility and increased inflammatory markers.
缺乏关于无急性静脉血栓栓塞症（VTE）疑诊的住院内科患者止血标志物与静脉血栓栓塞症（VTE）临床和生物学危险因素（RFs）之间相关性的数据。
为评估当前已知 VTE 风险因素患者的凝血激活状态，作者在 165 例无急性 VTE 疑诊的住院内科患者中，于入院第 1 天检测了 2 种高凝标志物：凝血酶-抗凝血酶（TAT）复合物和 D-二聚体。所有已知的 VTE RFs 均在入院时进行了系统评估，并按时间顺序分类为永久性或暂时性。
出乎意料的是，TAT 值呈多峰分布。D-二聚体经对数转换后呈正态分布（P =.34，Shapiro-Wilk 检验）。有趣的是，根据 RFs 的时间顺序分类，D-二聚体水平呈显著进展。在多变量分析中，D-二聚体的变化（由于 TAT 的多峰分布而不适用于 TAT）与近期无法行走和 C 反应蛋白水平升高超过 10mg/L 独立相关。
（a）本研究首次描述了无急性 VTE 疑诊的住院内科患者中，根据 VTE RFs 的系统筛查，高凝标志物的变化；（b）与住院内科患者相比，TAT 似乎是一种不太相关的高凝标志物；（c）RFs 的时间顺序分类明确确定了处于血栓前状态风险的组；（d）近期活动能力下降和炎症标志物升高的患者表现出高凝状态增加。
