Clinical Department of Cardiology, Clinical Hospital No. 2 in Rzeszów, Rzeszów, Poland.
Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland.
Thromb Res. 2019 Oct;182:141-149. doi: 10.1016/j.thromres.2019.08.010. Epub 2019 Aug 19.
Reduced clot permeability and lysability have been reported in patients who experienced venous thromboembolism (VTE) following lower limb injury despite pharmacological thromboprophylaxis. We hypothesized that similarly altered fibrin clot properties characterize patients with post-discharge VTE despite thromboprophylaxis during prior hospitalization due to acute medical illnesses.
In a case-control study, we assessed 48 patients who developed VTE within 4 weeks post-discharge despite pharmacological thromboprophylaxis during hospitalization (the thromboprophylaxis group) and three age- and sex-matched control groups (n = 48 each): (1) patients who developed VTE following hospitalization without pharmacological thromboprophylaxis (the no-thromboprophylaxis group), (2) patients with unprovoked VTE and (3) individuals without history of VTE (the no-VTE group). Blood samples were obtained following ≥3 months of anticoagulation in VTE patients. Fibrin clot properties, thrombin generation and fibrinolysis activators and inhibitors were assessed.
Compared with the no-VTE group, the thromboprophylaxis group formed denser fibrin networks reflected by lower clot permeability (K, -13%) and impaired fibrinolysis, as evidenced by prolonged clot lysis time (CLT, +14%) and lower rate of D-dimer release from clots (D-D, -9%) accompanied by elevated high-sensitivity C-reactive protein (hsCRP, +79%), peak thrombin generation (+55%) and α-antiplasmin (+10%, all p < 0.05). Similar fibrin clot features were observed following unprovoked VTE. The thromboprophylaxis group had also lower K (-13%), elevated α-antiplasmin (+18%) and higher peak thrombin generation (+25%, all p < 0.05) as compared with the no-thromboprophylaxis group.
Unfavorably altered plasma clot properties and increased thrombin generation characterize medical patients with post-discharge VTE despite receiving pharmacological thromboprophylaxis during hospitalization for acute conditions.
尽管下肢损伤后患者接受了药物性血栓预防，但仍有静脉血栓栓塞症（VTE）发生，其血凝块的通透性和可裂解性降低。我们假设，由于急性内科疾病住院期间接受了药物性血栓预防，即使在出院后仍发生 VTE 的患者，其纤维蛋白凝块特性也会发生类似改变。
在一项病例对照研究中，我们评估了 48 例患者，这些患者尽管在住院期间接受了药物性血栓预防，但在出院后 4 周内仍发生 VTE（血栓预防组），并与 3 个年龄和性别匹配的对照组（每组 48 例）进行了比较：（1）住院后无药物性血栓预防且发生 VTE 的患者（无血栓预防组）；（2）无诱因 VTE 患者；（3）无 VTE 病史的个体（无 VTE 组）。在 VTE 患者接受抗凝治疗≥3 个月后采集血液样本。评估纤维蛋白凝块特性、凝血酶生成以及纤溶激活剂和抑制剂。
与无 VTE 组相比，血栓预防组形成的纤维蛋白网络密度较低，表现为凝血块通透性降低（K 值，-13%）和纤溶受损，具体表现为凝血块溶解时间延长（CLT，+14%）和从凝块中释放的 D-二聚体减少（D-D，-9%），同时伴有高敏 C 反应蛋白（hsCRP）升高（hsCRP，+79%）、峰值凝血酶生成增加（+55%）和α-抗纤溶酶增加（+10%，均 P<0.05）。在无诱因 VTE 患者中也观察到类似的纤维蛋白凝块特征。与无血栓预防组相比，血栓预防组的 K 值也较低（-13%）、α-抗纤溶酶较高（+18%）和峰值凝血酶生成较高（+25%，均 P<0.05）。
尽管住院期间接受了药物性血栓预防，但患有急性内科疾病的出院后发生 VTE 的患者，其血浆凝块特性发生了不利改变，且凝血酶生成增加。
