Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
Ann Thorac Surg. 2014 Apr;97(4):1207-13. doi: 10.1016/j.athoracsur.2013.11.040. Epub 2014 Feb 6.
Antithrombin (AT) concentrations are reduced after cardiac surgery with cardiopulmonary bypass compared with the preoperative levels. Low postoperative AT is associated with worse short- and mid-term clinical outcomes. The aim of the study is to evaluate the effects of AT administration on activation of the coagulation and fibrinolytic systems, platelet function, and the inflammatory response in patients with low postoperative AT levels.
Sixty patients with postoperative AT levels of less than 65% were randomly assigned to receive purified AT (5000 IU in three administrations) or placebo in the postoperative intensive care unit. Thirty patients with postoperative AT levels greater than 65% were observed as controls. Interleukin 6 (a marker of inflammation), prothrombin fragment 1-2 (a marker of thrombin generation), plasmin-antiplasmin complex (a marker of fibrinolysis), and platelet factor 4 (a marker of platelet activation) were measured at six different times.
Compared with the no AT group and control patients, patients receiving AT showed significantly higher AT values until 48 hours after the last administration. Analysis of variance for repeated measures showed a significant effect of study treatment in reducing prothrombin fragment 1-2 (p=0.009; interaction with time sample, p=0.006) and plasmin-antiplasmin complex (p<0.001; interaction with time sample, p<0.001) values but not interleukin 6 (p=0.877; interaction with time sample, p=0.521) and platelet factor 4 (p=0.913; interaction with time sample, p=0.543). No difference in chest tube drainage, reopening for bleeding, and blood transfusion was observed.
Antithrombin administration in patients with low AT activity after surgery with cardiopulmonary bypass reduces postoperative thrombin generation and fibrinolysis with no effects on platelet activation and inflammatory response.
与术前水平相比，体外循环心脏手术后抗凝血酶 (AT) 浓度降低。术后 AT 水平较低与短期和中期临床结局较差相关。本研究旨在评估术后 AT 水平较低的患者给予 AT 治疗对凝血和纤溶系统激活、血小板功能和炎症反应的影响。
将 60 例术后 AT 水平低于 65%的患者随机分配至术后重症监护病房接受纯化 AT（5000IU 分三次给予）或安慰剂治疗。将术后 AT 水平大于 65%的 30 例患者作为对照。在六个不同时间点测量白细胞介素 6（炎症标志物）、凝血酶原片段 1-2（凝血酶生成标志物）、纤溶酶-抗纤溶酶复合物（纤溶标志物）和血小板因子 4（血小板激活标志物）。
与无 AT 组和对照组患者相比，接受 AT 治疗的患者在最后一次给药后 48 小时内 AT 值显著升高。重复测量方差分析显示，研究治疗在降低凝血酶原片段 1-2（p=0.009；与时间样本的交互作用，p=0.006）和纤溶酶-抗纤溶酶复合物（p<0.001；与时间样本的交互作用，p<0.001）值方面具有显著作用，但对白细胞介素 6（p=0.877；与时间样本的交互作用，p=0.521）和血小板因子 4（p=0.913；与时间样本的交互作用，p=0.543）无影响。胸腔引流管引流量、因出血再次开胸和输血方面无差异。
体外循环心脏手术后 AT 活性降低的患者给予 AT 治疗可降低术后凝血酶生成和纤溶，对血小板激活和炎症反应无影响。
