Oberweis Brandon S, Cuff Germaine, Rosenberg Andrew, Pardo Luis, Nardi Michael A, Guo Yu, Dweck Ezra, Marshall Mitchell, Steiger David, Stuchin Steven, Berger Jeffrey S
Department of Medicine, New York University Langone Medical Center, 530 First Avenue Skirball 9R, New York, NY, 10016, USA.
J Thromb Thrombolysis. 2014 Nov;38(4):430-8. doi: 10.1007/s11239-014-1078-1.
Hemostasis is a major concern during the perioperative period. Changes in platelet aggregation and coagulation factors may contribute to the delicate balance between thrombosis and bleeding. We sought to better understand perioperative hemostasis by investigating the changes in platelet aggregation and coagulation factors during the perioperative period. We performed a prospective cohort analysis of 70 subjects undergoing non-emergent orthopedic surgery of the knee (n = 28), hip (n = 35), or spine (n = 7) between August 2011 and November 2011. Plasma was collected preoperatively (T1), 1-h intraoperatively (T2), 1-h (T3), 24-h (T4) and 48-h (T5) postoperatively. Platelet function testing was performed using whole blood impedance aggregometry. Coagulation assays were performed for factor VII, factor VIII, von Willebrand Factor (vWF), and fibrinogen. Of the 70 patients, mean age was 64.1 ± 9.8 years, 61% were female, and 74% were Caucasian. Platelet activity decreased until 1 h postoperatively and then significantly increased above baseline at 24- and 48-h postoperatively. Compared to baseline, coagulation factors decreased intraoperatively. Factor VII activity continued to decrease, while FVIII, vWF, and fibrinogen all increased above baseline postoperatively. The results of our study indicate significant changes in platelet activity and coagulation factors during the perioperative period. Both platelet activity and markers of coagulation decrease during the intraoperative period and then some increase postoperatively. These changes may contribute to the hypercoagulabity and/or bleeding risk that occurs in the perioperative period. Future prospective studies aimed at correlating hemostatic changes with perioperative outcomes are warranted.
止血是围手术期的一个主要关注点。血小板聚集和凝血因子的变化可能导致血栓形成和出血之间的微妙平衡。我们试图通过研究围手术期血小板聚集和凝血因子的变化来更好地理解围手术期止血情况。我们对2011年8月至2011年11月期间接受非急诊膝关节（n = 28）、髋关节（n = 35）或脊柱（n = 7）骨科手术的70名受试者进行了前瞻性队列分析。术前（T1）、术中1小时（T2）、术后1小时（T3）、24小时（T4）和48小时（T5）采集血浆。使用全血阻抗聚集法进行血小板功能检测。对凝血因子VII、凝血因子VIII、血管性血友病因子（vWF）和纤维蛋白原进行凝血检测。70例患者的平均年龄为64.1±9.8岁，61%为女性，74%为白种人。血小板活性在术后1小时前下降，然后在术后24小时和48小时显著高于基线水平。与基线相比，术中凝血因子下降。凝血因子VII活性持续下降，而凝血因子VIII、vWF和纤维蛋白原在术后均高于基线水平。我们的研究结果表明围手术期血小板活性和凝血因子有显著变化。术中血小板活性和凝血指标均下降，术后有所升高。这些变化可能导致围手术期发生高凝状态和/或出血风险。未来有必要进行旨在将止血变化与围手术期结局相关联的前瞻性研究。
