Division of Cardiovascular & Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, Multi-Disciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, United Kingdom.
J Vasc Surg. 2013 Jun;57(6):1512-8. doi: 10.1016/j.jvs.2012.12.030. Epub 2013 Mar 13.
Abdominal aortic aneurysm (AAA) is associated with hypercoagulability, evidenced by increased markers of coagulation activation, including thrombin-antithrombin complex (TAT), prothrombin fragments 1 and 2 (F1+2), and D-dimer. Our aim was to compare the effect of endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) on changes in coagulation activation markers after intervention.
Consecutive patients with AAAs reaching their intervention threshold in a tertiary vascular referral unit in the United Kingdom were invited to participate. The coagulation markers TAT, F1+2, and D-dimer were measured in venous blood collected at baseline and at 5 months after intervention. A forward stepwise multiple linear regression model was used to identify whether treatment by OAR or EVAR had an effect on changes in coagulation factors, independent of significant covariates.
The study included 47 patients (14 EVAR, 33 OAR; 85% men) who were a median age of 76 years (range, 69.5-80 years). Aortic diameter at intervention was 5.9 cm (range, 5.5-6.8 cm). There were no significant differences in clinical, anthropometric, or hematologic parameters between groups. At baseline, TAT (P = .13), F1+2 (P = .08), and D-dimer (P = .11) were similar in EVAR and OAR patients. Postintervention, there was a significant increase in TAT (3.0 [2.1-6.0] vs 7.2 [6.3-8.4] ng/mL; P = .03), F1+2 (242 [189-323] vs 392 [312-494] ng/mL; P = .003), and D-dimer (457 [336-615] vs 1197 [840-1509] ng/mL; P = .002) in the EVAR group. No significant changes were observed after intervention in the OAR group.
AAA-related hypercoagulability persists after intervention, with increased TAT, F1+2, and D-dimer levels after EVAR. These findings suggest a potential period of increased cardiovascular risk in the postoperative period after EVAR.
腹主动脉瘤（AAA）与高凝状态有关，这表现在凝血激活标志物的增加，包括凝血酶-抗凝血酶复合物（TAT）、凝血酶原片段 1 和 2（F1+2）以及 D-二聚体。我们的目的是比较血管内动脉瘤修复（EVAR）和开放动脉瘤修复（OAR）对干预后凝血激活标志物变化的影响。
我们邀请了英国一家三级血管转诊中心达到干预阈值的连续 AAA 患者参与研究。在基线和干预后 5 个月，采集静脉血样测量 TAT、F1+2 和 D-二聚体。采用向前逐步多元线性回归模型，以确定 OAR 或 EVAR 治疗是否对凝血因子的变化有影响，这是独立于重要协变量的。
该研究共纳入 47 例患者（14 例 EVAR，33 例 OAR；85%为男性），平均年龄 76 岁（范围 69.5-80 岁）。介入时的主动脉直径为 5.9cm（范围 5.5-6.8cm）。两组间的临床、人体测量和血液学参数无显著差异。基线时，EVAR 和 OAR 患者的 TAT（P=0.13）、F1+2（P=0.08）和 D-二聚体（P=0.11）相似。干预后，EVAR 组 TAT（3.0[2.1-6.0] vs 7.2[6.3-8.4]ng/ml；P=0.03）、F1+2（242[189-323] vs 392[312-494]ng/ml；P=0.003）和 D-二聚体（457[336-615] vs 1197[840-1509]ng/ml；P=0.002）显著增加。OAR 组干预后无明显变化。
AAA 相关的高凝状态在干预后仍然存在，EVAR 后 TAT、F1+2 和 D-二聚体水平升高。这些发现提示 EVAR 术后的围手术期可能存在心血管风险增加的潜在时期。
