McFarland Craig P, Lind Stuart E
1 Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
2 Division of Hospital Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
Clin Appl Thromb Hemost. 2018 Jul;24(5):708-717. doi: 10.1177/1076029617746506. Epub 2018 Feb 13.
Anticoagulation therapy is administered to patients to prevent or stop thrombin generation in vivo. Although plasma tests of in vivo thrombin generation have been available for more than 2 decades, they are not routinely used in clinical trials or practice to monitor anticoagulation therapy. We observed a fall in one such marker, the D-dimer antigen, in patients receiving anticoagulation therapy. We therefore conducted a systematic review of the medical literature to document the change in serum biomarkers of thrombin generation following the initiation of anticoagulation therapy. Using a defined search strategy, we screened PubMed and Embase citations and identified full-length articles published in English. Eighteen articles containing serial changes in 1 of 3 markers of thrombin generation (D-dimer antigen, thrombin-antithrombin complexes, and prothrombin fragment 1+2 antigen levels) in the 14 days following the initiation of anticoagulation were identified. Even though the assays used varied considerably, each of the 3 markers of thrombin generation declined in the initial period of anticoagulation therapy, with changes evident as early as 1 day after beginning therapy. These observations provide a rationale for further exploration of these markers as measures of the adequacy of anticoagulation using classic as well as novel anticoagulants. Particular patient groups that would benefit from additional means of monitoring anticoagulation therapy are discussed.
抗凝治疗用于患者以预防或阻止体内凝血酶的生成。尽管体内凝血酶生成的血浆检测已存在20多年，但它们在临床试验或实践中并未常规用于监测抗凝治疗。我们观察到接受抗凝治疗的患者中一种此类标志物——D-二聚体抗原有所下降。因此，我们对医学文献进行了系统综述，以记录抗凝治疗开始后凝血酶生成的血清生物标志物的变化。我们使用既定的检索策略，筛选了PubMed和Embase数据库中的文献引用，并确定了以英文发表的全文文章。我们识别出18篇文章，这些文章包含了抗凝治疗开始后14天内凝血酶生成的3种标志物（D-二聚体抗原、凝血酶-抗凝血酶复合物和凝血酶原片段1+2抗原水平）中1种的系列变化。尽管所使用的检测方法差异很大，但凝血酶生成的这3种标志物在抗凝治疗初期均下降，早在开始治疗后1天就有明显变化。这些观察结果为进一步探索这些标志物作为使用传统及新型抗凝剂时抗凝充分性的衡量指标提供了理论依据。本文还讨论了将从额外的抗凝治疗监测手段中获益的特定患者群体。
