Weinberg L, Scurrah N, Parker F C, Dauer R, Marshall J, McCall P, Story D, Smith C, McNicol L
Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia.
Anaesth Intensive Care. 2011 Sep;39(5):847-53. doi: 10.1177/0310057X1103900508.
We investigated the possibility that despite postoperative derangements of routine laboratory coagulation tests, markers of coagulation activation and thrombin generation would be normal or increased in patients undergoing hepatic resection for cancer In addition to the conventional coagulation tests prothrombin time and activated partial thromboplastin time, we measured select markers of coagulation activation prothrombin fragments 1 and 2 (PF1 + 2), thrombin-antithrombin complexes and plasma von Willebrand Factor antigen in 21 patients undergoing hepatic resection. The impact of hepatic resection on coagulation and fibrinolysis was studied with thromboelastography. Preoperatively, routine laboratory coagulation and liver function tests were normal in all patients. On the first postoperative day, prothrombin time was prolonged (range 16 to 22 seconds) in eight patients (38%). For these patients, thromboelastography was normal in six (75%), PF1 + 2 was elevated in four (50%), and thrombin-antithrombin complexes and von Willebrand Factor antigen were elevated in all, which was evidence of acute phase reaction, sustained coagulation factor turnover and activation. By the fifth postoperative day, despite normalisation of prothrombin time, markers of increased coagulation activity remained greater than 85% of baseline values. The findings indicate that in patients undergoing liver resection for cancer, there is significant and prolonged postoperative activation of the haemostatic system despite routine coagulation tests being normal or even prolonged. Before considering therapeutic interventions an integrated approach to interpreting haematological data with clinical correlation is essential.
我们研究了一种可能性，即尽管接受癌症肝切除手术的患者术后常规实验室凝血试验出现紊乱，但凝血激活标志物和凝血酶生成指标仍可能正常或升高。除了常规凝血试验凝血酶原时间和活化部分凝血活酶时间外，我们还对21例接受肝切除手术的患者测定了凝血激活的特定标志物凝血酶原片段1和2（PF1 + 2）、凝血酶 - 抗凝血酶复合物以及血浆血管性血友病因子抗原。采用血栓弹力图研究肝切除对凝血和纤溶的影响。术前，所有患者的常规实验室凝血和肝功能检查均正常。术后第一天，8例患者（38%）的凝血酶原时间延长（范围为16至22秒）。对于这些患者，6例（75%）的血栓弹力图正常，4例（50%）的PF1 + 2升高，所有患者的凝血酶 - 抗凝血酶复合物和血管性血友病因子抗原均升高，这是急性期反应、持续凝血因子周转和激活的证据。到术后第五天，尽管凝血酶原时间恢复正常，但凝血活性增加的标志物仍高于基线值的85%。研究结果表明，对于接受癌症肝切除手术的患者，尽管常规凝血试验正常甚至延长，但术后止血系统仍有显著且持续的激活。在考虑治疗干预之前，采用综合方法结合临床相关性解读血液学数据至关重要。
