Department of Urology, Medical and Health Science Center, University of Debrecen, Hungary.
PLoS One. 2012;7(12):e51299. doi: 10.1371/journal.pone.0051299. Epub 2012 Dec 7.
Recent studies provided evidence that evaluation of thrombin generation identifies patients at thrombotic risk. Thrombin generation has a central role in hemorrhage control and vascular occlusion and its measurement provides new metrics of these processes providing sufficient evaluation of an individual's hemostatic competence and response to anticoagulant therapy. The objective of the study is to assess a new measure of hypercoagulability that predisposes to venous thromboembolism in the postoperative period after radical prostatectomy. Pre- (day-1) and postoperative (hour 1, day 6, month 1 and 10) blood samples of 24 patients were tested for plasma thrombin generation (peak thrombin), routine hematology and hemostasis. Patients received low molecular weight heparin for thromboprophylaxis. Peak thrombin levels were higher in patients compared to controls at baseline (p<0.001), and elevated further in the early postoperative period (p<0.001). Longer general anesthesia and high body mass index were associated with increased thrombin generation after surgery (p = 0.024 and p = 0.040). D dimer and fibrinogen levels were higher after radical prostatectomy (p = 0.001 and p<0.001). Conventional clotting tests remained within the reference range. Our study contributed to the cognition of the hypercoagulable state in cancer patients undergoing pelvic surgery and revealed the course of thrombin generation after radical prostatectomy. Whilst it is unsurprising that thrombin generation increases after tissue trauma, further evaluation of this condition during the postoperative period would lead urologists to an international and well-supported consensus regarding thromboprophylaxis in order to provide better clinical outcome. Considering the routine evaluation of procoagulant activity and extending prophylactic anticoagulant therapy accordingly may potentially prevent late thrombotic events.
最近的研究表明，评估凝血酶生成可识别处于血栓形成风险中的患者。凝血酶生成在控制出血和血管闭塞中起着核心作用，其测量提供了这些过程的新指标，充分评估了个体的止血能力和对抗凝治疗的反应。本研究旨在评估一种新的高凝状态度量标准，该标准可预测根治性前列腺切除术后的静脉血栓栓塞。对 24 例患者的术前（第 1 天）和术后（第 1 小时、第 6 天、第 1 个月和第 10 个月）血样进行血浆凝血酶生成（最大凝血酶）、常规血液学和止血检测。患者接受低分子肝素预防血栓形成。与对照组相比，患者的最大凝血酶水平在基线时更高（p<0.001），并在术后早期进一步升高（p<0.001）。较长的全身麻醉时间和较高的体重指数与术后凝血酶生成增加相关（p=0.024 和 p=0.040）。D 二聚体和纤维蛋白原水平在根治性前列腺切除术后升高（p=0.001 和 p<0.001）。常规凝血测试仍在参考范围内。本研究有助于认识接受骨盆手术的癌症患者的高凝状态，并揭示了根治性前列腺切除术后凝血酶生成的过程。尽管组织创伤后凝血酶生成增加并不奇怪，但进一步评估术后期间的这种情况可能会使泌尿科医生就骨盆手术患者的预防性抗凝治疗达成国际共识和支持，以提供更好的临床结果。考虑到常规评估促凝活性并相应地延长预防性抗凝治疗可能有助于预防晚期血栓事件。
