Friedrich Max Julian, Schmolders Jan, Rommelspacher Yorck, Strauss Andreas, Rühl Heiko, Mayer Günter, Oldenburg Johannes, Wirtz Dieter Christian, Müller Jens, Pötzsch Bernd
Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany.
TH Open. 2018 Oct 1;2(4):e350-e356. doi: 10.1055/s-0038-1673390. eCollection 2018 Oct.
In the nonbleeding patient, constant low-level activation of coagulation enables a quick procoagulant response upon an injury. Conversely, local activation of coagulation might influence the systemic activity level of coagulation. To characterize this interaction in more detail, activity pattern analysis was performed in patients undergoing elective surgeries. Blood samples were taken before, during, and 24 hours after surgery from 35 patients undergoing elective minor ( = 18) and major ( = 17) orthopaedic surgeries. Plasma levels of thrombin and activated protein C (APC) were measured using oligonucleotide-based enzyme capture assays, while those of prothrombin fragment 1.2, thrombin-antithrombin-complexes, and D-dimer were measured using commercially available enzyme-linked immunosorbent assays. In vitro thrombin generation kinetics were recorded using calibrated automated thrombography. Results showed that median plasma levels of up to 20 pM thrombin and of up to 12 pM APC were reached during surgery. D-dimer levels started to increase at the end of surgery and remained increased 24 hours after surgery, while all other parameters returned to baseline. Peak levels showed no significant differences between minor and major surgeries and were not influenced by the activity state at baseline. In vitro thrombin generation kinetics remained unchanged during surgery. In summary, simultaneous monitoring of the procoagulant and anticoagulant pathways of coagulation demonstrates that surgical trauma is associated with increased systemic activities of both pathways. Activity pattern analysis might be helpful to identify patients at an increased risk for thrombosis due to an imbalance between surgery-related thrombin formation and the subsequent anticoagulant response.
在无出血的患者中，凝血的持续低水平激活可使机体在受伤时迅速产生促凝反应。相反，局部凝血激活可能会影响凝血的全身活性水平。为了更详细地描述这种相互作用，我们对接受择期手术的患者进行了活性模式分析。从35例接受择期小型（n = 18）和大型（n = 17）骨科手术的患者中，在手术前、手术期间和手术后24小时采集血样。使用基于寡核苷酸的酶捕获测定法测量血浆凝血酶和活化蛋白C（APC）的水平，而使用市售的酶联免疫吸附测定法测量凝血酶原片段1.2、凝血酶 - 抗凝血酶复合物和D - 二聚体的水平。使用校准的自动血栓成像记录体外凝血酶生成动力学。结果显示，手术期间血浆凝血酶水平中位数高达20 pM，APC水平高达12 pM。D - 二聚体水平在手术结束时开始升高，并在手术后24小时持续升高，而所有其他参数均恢复至基线水平。小型手术和大型手术的峰值水平无显著差异，且不受基线活性状态的影响。手术期间体外凝血酶生成动力学保持不变。总之，同时监测凝血的促凝和抗凝途径表明，手术创伤与这两种途径的全身活性增加有关。活性模式分析可能有助于识别因手术相关凝血酶形成与随后的抗凝反应失衡而血栓形成风险增加的患者。
