Hemorheology and Haemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain.
Clin Hemorheol Microcirc. 2013;53(1-2):131-41. doi: 10.3233/CH-2012-1581.
The role played by hemorheological alterations in the development of deep vein thrombosis (DVT) has often been overlooked. Although marked rheological alterations and the relationship with thromboembolic events are well-defined in patients with hematological diseases such as myelom, Waldenström disease and polycythemia vera, the relationship is not so clear in patients without hematological diseases. In the present review, we analyzed studies evaluating the rheological profile in DVT patients. Among the cardiovascular risk factors, only hyperlipidemia, metabolic syndrome, tobacco and obesity increase DVT risk and, in addition, a disturbed rheological profile is shown which could further increase this risk. The significance of hematocrit and fibrinogen, the main factors influencing blood viscosity, is not sufficient to increase blood viscosity in any of the studies analyzed. DVT patients show increased fibrinogen levels and erythrocyte aggregation throughout all the studies despite patients not being in an acute reactant phase. In addition to rheological alterations, it is necessary to consider local conditions at pockets of venous valves which undergo deterioration with aging and play an important role equally to alterations in the rheological profile. Moreover, it is necessary to take into account that systemic rheological alterations are not comparable to those in low shear rate areas where minimum disturbances could be more relevant. It would be convenient to perform multicentric studies with the same rheological methodology and pre-analytical procedures to evaluate, in order to obviate the effect of thrombophilic and circumstantial risk factors, rheological parameters in patients with spontaneous DVT to elucidate their real contribution to the development of thromboembolic events.
血液流变学改变在深静脉血栓形成（DVT）发展中的作用经常被忽视。虽然在血液疾病患者中，如骨髓瘤、瓦尔登斯特伦巨球蛋白血症和真性红细胞增多症，明显的流变学改变与血栓栓塞事件之间的关系已得到明确界定，但在无血液疾病的患者中，这种关系并不明确。在本综述中，我们分析了评估 DVT 患者血流变学特征的研究。在心血管危险因素中，只有高脂血症、代谢综合征、烟草和肥胖症会增加 DVT 的风险，此外，还显示出一种紊乱的血流变学特征，这可能进一步增加这种风险。尽管在分析的所有研究中，红细胞压积和纤维蛋白原这两个主要影响血液粘度的因素都不足以增加血液粘度，但它们的意义并不充分。DVT 患者表现出纤维蛋白原水平升高和红细胞聚集，尽管患者没有处于急性反应期。除了血流变学改变外，还需要考虑静脉瓣膜口袋处的局部情况，这些情况会随着年龄的增长而恶化，并且与血流变学特征的改变同样重要。此外，有必要考虑到全身血流变学改变与低剪切率区的改变不同，后者的最小干扰可能更为相关。进行具有相同血流变学方法和预分析程序的多中心研究，以评估自发性 DVT 患者的血流变学参数，以排除血栓形成和环境危险因素的影响，从而阐明它们对血栓栓塞事件发展的真正贡献，这将是很方便的。
