Shipov Anna, Milgram Josh, Shalev Nitzan, Aroch Itamar, Segev Gilad
Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot 761001, Israel.
Vet Surg. 2018 Apr;47(3):406-411. doi: 10.1111/vsu.12779. Epub 2018 Feb 21.
D-dimer is a specific marker of active coagulation and fibrinolysis. The objective of this study is to determine the influence of surgery on D-dimer concentration as well as to examine the relation between the magnitude of change and invasiveness of the surgical procedures.
Prospective clinical study.
Forty-five client-owned dogs undergoing elective neutering (n = 15), elective orthopedic (n = 15), or posttraumatic orthopedic (n = 15) surgical procedures.
Dogs undergoing elective neutering, elective orthopedic, and posttraumatic orthopedic surgical procedures were enrolled. D-dimer concentration, measured immediately prior to, immediately after, and 24 hours after surgery (T0, T1, and T24, respectively), was compared within and among study groups.
D-dimer concentration was >250 ng/mL in 8 (18%) dogs at T0, in 9 (20%) at T1, and in 5 (11%) at T24. At T1 and T24, only 2 dogs had a D-dimer concentration >500 ng/mL, and it was <750 ng/mL in all dogs. There was no difference in the proportion of increased D-dimer concentration (>250 ng/mL) among the time points (P = 0.29). Median D-dimer concentration did not vary between time points within the groups, except in the neutering group (P = 0.029), in which T1 concentration tended to increase compared with T0 values (161 ng/dL, range 71-727 vs 122 ng/mL, range, 43-353, respectively; P = .065).
The surgical procedures tested in this study are unlikely to cause a direct increase in D-dimer concentration.
Any increase in D-dimer concentration after elective neutering, elective orthopedic, and posttraumatic orthopedic surgical procedures should be regarded as clinically important and trigger investigations to detect a hemostatic derangement.
D - 二聚体是活跃凝血和纤维蛋白溶解的特异性标志物。本研究的目的是确定手术对D - 二聚体浓度的影响，并研究变化幅度与手术侵袭性之间的关系。
前瞻性临床研究。
45只客户拥有的犬，接受择期去势手术（n = 15）、择期骨科手术（n = 15）或创伤后骨科手术（n = 15）。
纳入接受择期去势、择期骨科和创伤后骨科手术的犬。比较手术前即刻、手术后即刻和术后24小时（分别为T0、T1和T24）测量的D - 二聚体浓度，在各研究组内及组间进行比较。
在T0时，8只（18%）犬的D - 二聚体浓度>250 ng/mL，T1时为9只（20%），T24时为5只（11%）。在T1和T24时，只有2只犬的D - 二聚体浓度>500 ng/mL，所有犬的浓度均<750 ng/mL。各时间点D - 二聚体浓度升高（>250 ng/mL）的比例无差异（P = 0.29）。除去势组外（P = 0.029），各组内各时间点的D - 二聚体浓度中位数无变化，去势组中T1浓度与T0值相比有升高趋势（分别为161 ng/dL，范围71 - 727与122 ng/mL，范围43 - 353；P = 0.065）。
本研究中测试的手术不太可能直接导致D - 二聚体浓度升高。
择期去势、择期骨科和创伤后骨科手术后D - 二聚体浓度的任何升高都应被视为具有临床重要性，并引发检测止血紊乱的调查。
