Aota Takumi, Naitoh Katsuki, Wada Hideo, Yamashita Yoshiki, Miyamoto Noriki, Hasegawa Masahiro, Wakabayashi Hiroki, Yoshida Kakunoshin, Asanuma Kunihiro, Matsumoto Takeshi, Ohishi Kohshi, Shimokariya Yuji, Yamada Norikazu, Nishikawa Masakatsu, Katayama Naoyuki, Uchida Atsumasa, Sudo Akihiro
Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan.
Int J Hematol. 2014 Nov;100(5):450-6. doi: 10.1007/s12185-014-1676-x. Epub 2014 Sep 25.
Prevention of deep vein thrombosis (DVT) is important in patients undergoing major orthopedic surgery. Although the detection of an elevated D-dimer level is useful for predicting DVT, it is not efficacious in postoperative patients being treated with anti-Xa agents. The soluble platelet glycoprotein VI (sGPVI) level is a marker of activated platelets, but not bleeding. Therefore, sGPVI levels are usually examined as a predictor of DVT in such patients. In the present study, 83 orthopedic patients were treated with 30 mg of edoxaban for prophylaxis of DVT. Fourteen patients developed DVT and 17 patients discontinued the prophylaxis due to decreased hemoglobin levels. Plasma levels of sGPVI in the patients were significantly higher after surgery than before surgery. On day 1, the sGPVI levels increased, while the platelet counts decreased. There were no significant differences in D-dimer, soluble fibrin, or FDP levels in orthopedic patients with and without DVT before surgery and on days 1, 4, and 8. Plasma sGPVI levels were significantly higher in the patients with DVT than in those without DVT on days 1 and 4. Plasma levels of D-dimer were significantly higher in patients with withdrawal than in those without. However, there were no significant differences in sGPVI levels between those with and without withdrawal. As D-dimer levels are known to increase in patients with withdrawal, this parameter is not useful for evaluating the risk of DVT in these patients. In contrast, the sGPVI level is not increased in those with withdrawal and may therefore be useful for evaluating the risk of DVT in postoperative patients treated with an anticoagulant.
预防深静脉血栓形成（DVT）对于接受大型骨科手术的患者至关重要。尽管检测D - 二聚体水平升高有助于预测DVT，但在接受抗Xa因子药物治疗的术后患者中，它并不有效。可溶性血小板糖蛋白VI（sGPVI）水平是活化血小板的标志物，但与出血无关。因此，通常检测sGPVI水平作为此类患者DVT的预测指标。在本研究中，83名骨科患者接受30mg依度沙班预防DVT。14名患者发生DVT，17名患者因血红蛋白水平下降而停止预防。患者术后血浆sGPVI水平显著高于术前。在第1天，sGPVI水平升高，而血小板计数下降。术前以及术后第1天、第4天和第8天，发生DVT和未发生DVT的骨科患者的D - 二聚体、可溶性纤维蛋白或FDP水平无显著差异。在第1天和第4天，发生DVT的患者血浆sGPVI水平显著高于未发生DVT的患者。停药患者的血浆D - 二聚体水平显著高于未停药患者。然而，停药患者与未停药患者的sGPVI水平无显著差异。由于已知停药患者的D - 二聚体水平会升高，因此该参数对于评估这些患者的DVT风险并无用处。相比之下，停药患者的sGPVI水平并未升高，因此它可能有助于评估接受抗凝治疗的术后患者的DVT风险。
