Lind Marcus, Boman Kurt, Johansson Lars, Nilsson Torbjörn K, Järvholm Lisbeth Slunga, Jansson Jan-Håkan
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Clin Biochem. 2014 May;47(7-8):570-3. doi: 10.1016/j.clinbiochem.2014.03.003. Epub 2014 Mar 15.
Previous studies have shown that biomarkers in blood plasma can predict bleeding complications during anticoagulant treatment as well as thromboembolic events and may improve existing risk stratification schemes in patients on or considered for oral anticoagulant treatment. The aim of this study was to investigate if levels of d-dimer, tissue plasminogen activator (tPA) and its complex with plasminogen inhibitor type 1 (tPA/PAI-1 complex) can predict major bleedings, cardiovascular events and all-cause mortality in patients with warfarin treatment.
In a longitudinal cohort study, 719 patients on oral anticoagulant treatment were followed for a total of 3001 treatment years. Major bleeding, stroke, arterial emboli, myocardial infarction and death were recorded and classified. Blood samples collected at baseline were analyzed for d-dimer, tPA, and tPA/PAI-1 complex.
In multivariate Cox regression analysis, high levels of d-dimer were associated with major bleeding (HR 1.27 per SD; 95% CI: 1.01-1.60), cardiovascular events (HR 1.23 per SD; 95% CI: 1.05-1.45) and all-cause mortality (HR 1.25 per SD; 95% CI: 1.06-1.47). Neither tPA nor the tPA/PAI-1 complex was associated with major bleeding, cardiovascular events or all-cause mortality.
We conclude that high levels of d-dimer predict major bleeding, cardiovascular events and all-cause mortality during warfarin treatment.
既往研究表明，血浆生物标志物可预测抗凝治疗期间的出血并发症以及血栓栓塞事件，并可能改善正在接受或考虑接受口服抗凝治疗患者的现有风险分层方案。本研究的目的是调查D - 二聚体、组织型纤溶酶原激活剂（tPA）及其与1型纤溶酶原抑制剂的复合物（tPA/PAI - 1复合物）水平是否能够预测华法林治疗患者的大出血、心血管事件和全因死亡率。
在一项纵向队列研究中，对719例接受口服抗凝治疗的患者进行了总计3001个治疗年的随访。记录并分类大出血、中风、动脉栓塞、心肌梗死和死亡情况。对基线时采集的血样进行D - 二聚体、tPA和tPA/PAI - 1复合物分析。
在多变量Cox回归分析中，高水平的D - 二聚体与大出血（每标准差风险比1.27；95%置信区间：1.01 - 1.60）、心血管事件（每标准差风险比1.23；95%置信区间：1.05 - 1.45）和全因死亡率（每标准差风险比1.25；95%置信区间：1.06 - 1.47）相关。tPA和tPA/PAI - 1复合物均与大出血、心血管事件或全因死亡率无关。
我们得出结论，高水平的D - 二聚体可预测华法林治疗期间的大出血、心血管事件和全因死亡率。
