冠状动脉血运重建患者的高凝状态自然史和术前心肌梗死的影响。
Natural history of hypercoagulability in patients undergoing coronary revascularization and effect of preoperative myocardial infarction.
机构信息
Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, The Baird Institute, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; ANZAC Research Institute, Sydney, Australia.
ANZAC Research Institute, Sydney, Australia.
出版信息
J Thorac Cardiovasc Surg. 2014 Aug;148(2):536-43. doi: 10.1016/j.jtcvs.2013.10.028. Epub 2013 Nov 23.
OBJECTIVES
The balance between hyper- and hypocoagulable states is critical after coronary artery surgery both with (coronary artery bypass grafting [CABG]) and without (off-pump coronary artery bypass [OPCAB]) cardiopulmonary bypass to prevent thrombotic or bleeding complications. We aimed to quantify novel parameters of coagulation, fibrinolysis, and overall hemostasis ≤6 months after CABG and OPCAB and to determine the influences on these parameters.
METHODS
A total of 63 patients (30 CABG, 33 OPCAB) had blood collected before and at various points ≤6 months after surgery. Fibrin and fibrinolysis time curves were generated by measuring the absorption of 405 nm each minute for 100 minutes after the addition of tissue factor and tissue plasminogen activator to cell-free plasma. The parameters were compared with those from a group of healthy controls.
RESULTS
The patients' preoperative prothrombotic assay parameters were compared with those from healthy controls. Both CABG and OPCAB patients were hypercoagulable until at least day 10 after surgery, with elevation of fibrin generation (CABG, peak day 3, +28.9%; OPCAB, peak day 1, +16.3% vs preoperative baseline) and impairment of fibrinolysis capacity (CABG, day 1, -58.4%; OPCAB, day 1, -22.6%). Surgical revascularization resulted in resolution of preoperative hypercoagulability by 6 months postoperatively. Patients with preoperative myocardial infarction (MI) had prolonged hypercoagulability after surgery that was most exaggerated after CABG (overall hemostatic potential day 5, no MI, +64.1% vs with MI, +128.9% compared with baseline; P = .013).
CONCLUSIONS
Patients will be vulnerable to thrombotic events for ≤6 weeks after coronary surgery yet will have resolution of hypercoagulability by 6 months. Preoperative factors, such as MI, could require individualized management of thrombosis prophylaxis in the postoperative period.
目的
在进行冠状动脉旁路移植术（CABG）和不停跳冠状动脉旁路移植术（OPCAB）时，为了预防血栓形成或出血并发症，在冠状动脉手术后的 6 个月内，需要保持高凝和低凝状态之间的平衡。我们旨在定量评估 CABG 和 OPCAB 术后 6 个月内新型凝血、纤溶和整体止血参数，并确定这些参数的影响因素。
方法
共 63 例患者（30 例 CABG，33 例 OPCAB）在术前和术后 ≤6 个月的不同时间点采集血液。在无细胞血浆中加入组织因子和组织纤溶酶原激活剂后，每分钟测量 405nm 的吸光度 100 分钟，生成纤维蛋白和纤溶时间曲线。将这些参数与一组健康对照组进行比较。
结果
与健康对照组相比，CABG 和 OPCAB 患者的术前血栓形成前检测参数升高。CABG 和 OPCAB 患者在手术后至少 10 天内仍处于高凝状态，纤维蛋白生成增加（CABG：峰值第 3 天，增加 28.9%；OPCAB：峰值第 1 天，增加 16.3%，与术前基线相比），纤溶能力受损（CABG：第 1 天，减少 58.4%；OPCAB：第 1 天，减少 22.6%）。手术再血管化可在术后 6 个月内消除术前高凝状态。术前心肌梗死（MI）的患者在手术后仍存在持续的高凝状态，在 CABG 后更为明显（整体止血潜能第 5 天，无 MI，增加 64.1%；有 MI，增加 128.9%，与基线相比；P=0.013）。
结论
患者在冠状动脉手术后的 ≤6 周内易发生血栓形成事件，但在 6 个月内会恢复正常的高凝状态。术前因素，如 MI，可能需要在术后期间对血栓预防进行个体化管理。
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