Pengo V, Peruzzi P, Baca M, Marzari A, Zanon F, Schivapappa L, Dalla Volta S
Department of Cardiology, Padua University, Padova, Italy.
Eur J Clin Invest. 1989 Apr;19(2):181-4. doi: 10.1111/j.1365-2362.1989.tb00215.x.
Fibrinopeptide A is a good marker of in vivo thrombin formation. The aim of oral anticoagulants (OA) is to lower in vivo thrombin formation. We therefore assessed FpA levels on several occasions in 38 patients receiving OA for artificial heart valve prostheses and in 20 patients receiving OA for biological heart valve prostheses. The mean FpA level, 1.82 ng ml-1 (SEM 0.14, n = 176), in patients with artificial valves was significantly higher than the mean, 1.02 ng ml-1 (SEM 0.4), obtained in 41 healthy subjects (P = 0.01). FpA mean value for biological valves was 1.41 ng ml-1 (SEM 0.14, n = 76), which was not significantly higher than controls (P = 0.08). A decrease in FpA levels, for both artificial and biological heart valve prostheses, was associated with a parallel increase in the intensity of anticoagulation. When considering FpA values obtained in the optimal therapeutic range for oral anticoagulant treatment, (International Normalized Ratio [INR] between 3 and 4.5), the mean level for artificial valves, 1.87 ng ml-1 (SEM 0.18, n = 102), was significantly higher than the mean value, 1.25 ng ml-1 (SEM 0.16, n = 55), obtained for biological valves. From a biological point of view, this indicates that artificial valves should be kept at a higher intensity of anticoagulation.
纤维蛋白肽A是体内凝血酶形成的良好标志物。口服抗凝剂（OA）的目的是降低体内凝血酶的形成。因此，我们多次评估了38例接受人工心脏瓣膜置换术并服用OA的患者以及20例接受生物心脏瓣膜置换术并服用OA的患者的纤维蛋白肽A水平。人工瓣膜患者的纤维蛋白肽A平均水平为1.82 ng/ml（标准误0.14，n = 176），显著高于41名健康受试者的平均水平1.02 ng/ml（标准误0.4）（P = 0.01）。生物瓣膜的纤维蛋白肽A平均值为1.41 ng/ml（标准误0.14，n = 76），显著高于对照组（P = 0.08）。对于人工和生物心脏瓣膜置换术，纤维蛋白肽A水平的降低与抗凝强度的平行增加相关。当考虑口服抗凝治疗最佳治疗范围内（国际标准化比值[INR]在3至4.5之间）获得的纤维蛋白肽A值时，人工瓣膜的平均水平1.87 ng/ml（标准误0.18，n = 102）显著高于生物瓣膜的平均值1.25 ng/ml（标准误0.16，n = 55）。从生物学角度来看，这表明人工瓣膜应保持更高的抗凝强度。
