Donkin Rebecca, Fung Yoke Lin, Singh Indu
The University of the Sunshine Coast, School of Health and Behavioural Sciences, Sippy Downs, QLD, Australia.
Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia.
Subcell Biochem. 2023;102:313-342. doi: 10.1007/978-3-031-21410-3_12.
The World Health Organization estimates that the world's population over 60 years of age will nearly double in the next 30 years. This change imposes increasing demands on health and social services with increased disease burden in older people, hereafter defined as people aged 60 years or more. An older population will have a greater incidence of cardiovascular disease partly due to higher levels of blood fibrinogen, increased levels of some coagulation factors, and increased platelet activity. These factors lead to a hypercoagulable state which can alter haemostasis, causing an imbalance in appropriate coagulation, which plays a crucial role in the development of cardiovascular diseases. These changes in haemostasis are not only affected by age but also by gender and the effects of hormones, or lack thereof in menopause for older females, ethnicity, other comorbidities, medication interactions, and overall health as we age. Another confounding factor is how we measure fibrinogen and coagulation through laboratory and point-of-care testing and how our decision-making on disease and treatment (including anticoagulation) is managed. It is known throughout life that in normal healthy individuals the levels of fibrinogen and coagulation factors change, however, reference intervals to guide diagnosis and management are based on only two life stages, paediatric, and adult ranges. There are no specific diagnostic guidelines based on reference intervals for an older population. How ageing relates to alterations in haemostasis and the impact of the disease will be discussed in this chapter. Along with the effect of anticoagulation, laboratory testing of fibrinogen and coagulation, future directions, and implications will be presented.
世界卫生组织估计，在未来30年里，全球60岁及以上的人口数量将几乎翻一番。这一变化给卫生和社会服务带来了越来越高的需求，因为老年人（以下定义为60岁及以上的人群）的疾病负担在增加。老年人群中心血管疾病的发病率会更高，部分原因是血纤维蛋白原水平升高、某些凝血因子水平增加以及血小板活性增强。这些因素会导致血液高凝状态，进而改变止血过程，引起凝血失衡，而凝血失衡在心血管疾病的发展过程中起着关键作用。止血方面的这些变化不仅受年龄影响，还受性别、激素作用（对于老年女性而言，绝经后激素缺乏）、种族、其他合并症、药物相互作用以及随着年龄增长而出现的整体健康状况的影响。另一个混杂因素是我们如何通过实验室检测和即时检测来测量纤维蛋白原和凝血情况，以及我们如何对疾病和治疗（包括抗凝治疗）进行决策管理。众所周知，在正常健康个体的一生中，纤维蛋白原和凝血因子的水平会发生变化，然而，用于指导诊断和管理的参考区间仅基于两个生命阶段，即儿科和成人范围。目前尚无基于老年人群参考区间的具体诊断指南。本章将讨论衰老与止血变化的关系以及疾病的影响。同时还将介绍抗凝作用、纤维蛋白原和凝血的实验室检测、未来方向及影响。
