Division of Internal Medicine, Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland.
Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231158369. doi: 10.1177/10760296231158369.
Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with thrombotic states including elevated coagulation factor VIII (FVIII). Pulmonary endarterectomy (PEA) is the main treatment for CTEPH, and efficient anticoagulation is essential to prevent thromboembolism recurrence after surgery. We aimed to characterize longitudinal changes in FVIII and other coagulation biomarkers after PEA.
Coagulation biomarker levels were measured at baseline and up to 12 months after operation in 17 consecutive patients with PEA. Temporal patterns of coagulation biomarkers, and correlation of FVIII with other coagulation biomarkers, were analyzed.
Baseline FVIII levels were elevated in 71% of the patients (mean 216 ± 67 IU/dl). FVIII doubled 7 days after PEA, peaking at 471 ± 87 IU/dl, and gradually returned to respective baseline levels within 3 months. Postoperative fibrinogen levels were also elevated. Antithrombin decreased at 1 to 3 days, D-dimer increased at 1 to 4 weeks, and thrombocytosis was observed at 2 weeks.
FVIII is elevated in most patients with CTEPH. After PEA, early but transient elevation of FVIII and fibrinogen, and delayed reactive thrombocytosis, occurs, and warrants careful postoperative anticoagulation to prevent thromboembolism recurrence.
慢性血栓栓塞性肺动脉高压（CTEPH）与包括凝血因子 VIII （FVIII）升高在内的血栓形成状态有关。肺动脉内膜切除术（PEA）是 CTEPH 的主要治疗方法，有效的抗凝对于预防手术后血栓栓塞复发至关重要。我们旨在描述 PEA 后 FVIII 和其他凝血生物标志物的纵向变化。
在 17 例连续接受 PEA 的患者中，在基线时和术后长达 12 个月时测量凝血生物标志物水平。分析凝血生物标志物的时间模式以及 FVIII 与其他凝血生物标志物的相关性。
71%的患者基线 FVIII 水平升高（平均 216±67IU/dl）。PEA 后 7 天 FVIII 增加一倍，达到 471±87IU/dl，并在 3 个月内逐渐恢复到各自的基线水平。术后纤维蛋白原水平也升高。抗凝血酶在 1 至 3 天下降，D-二聚体在 1 至 4 周增加，2 周时出现血小板增多。
大多数 CTEPH 患者的 FVIII 升高。PEA 后，早期但短暂的 FVIII 和纤维蛋白原升高，以及延迟的反应性血小板增多，需要术后仔细抗凝以预防血栓栓塞复发。
