Polok Kamil Jurand, Górka Jacek, Fronczek Jakub, Górka Karolina, Kaczmarek Bogusz, Iwaniec Teresa, Iwaszczuk Paweł, Musiał Jacek, Szczeklik Wojciech
Jagiellonian University Medical College Department of Intensive Care and Perioperative Medicine Kraków Poland Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
Jagiellonian University Medical College Department of Medicine Kraków Poland Department of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Braz J Cardiovasc Surg. 2019 Jun 1;34(3):327-334. doi: 10.21470/1678-9741-2018-0238.
The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways.
We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate < 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure.
Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P<0.001), antithrombin (92.1 vs. 74.8, P<0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P<0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21).
Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.
本研究的主要目的是评估血管手术对止血和纤溶途径活性的影响。
我们纳入了38例年龄≥45岁、在全身或区域麻醉下接受腹主动脉瘤或外周动脉疾病手术且术后至少住院一晚的患者。接受颈动脉手术的患者以及那些有急性旁路移植血栓形成、癌症、定义为估计肾小球滤过率<30 ml/min/1.73m²的肾衰竭、手术前三个月有静脉血栓栓塞或急性感染的患者被排除在研究之外。我们在血管手术后6 - 12小时及术前测量了止血标志物（因子VIII、血管性血友病因子：瑞斯托霉素辅因子[vWF:CoR]、抗凝血酶）、纤溶标志物（D - 二聚体、组织纤溶酶原激活物[tPA]、纤溶酶 - 抗纤溶酶复合物）以及可溶性分化簇40配体（sCD40L）的水平。
观察到术前和术后因子VIII水平（158.0对103.3，P<0.001）、抗凝血酶水平（92.1对74.8，P<0.001）、D - 二聚体水平（938.0对2406.0，P = 0.005）、tPA水平（10.1对12.8，P = 0.002）和sCD40L水平（9092.9对1249.6，P<0.001）存在显著差异。术前和术后vWF:CoR水平（140.6对162.8，P = 0.17）和纤溶酶 - 抗纤溶酶复合物水平（749.6对863.7，P = 0.21）无显著差异。
血管手术导致止血和纤溶系统发生显著改变。然而，这两条途径中这些变化的方向仍不清楚，并且似乎因手术类型而异。有必要对更大规模人群进行利用动态凝血和纤溶评估方法的研究。
