Strasser Bernhard, Knotzer Johann, Sartori Selina, Poidinger Bernhard, Kotzinger Oskar, Irsara Christian, Lirk Gerald, Gunz Carolin, Haushofer Alexander
Institute of Clinical Chemistry and Laboratory Medicine, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.
Department of Anaesthesiology and Critical Care, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.
J Clin Med. 2025 Jul 11;14(14):4936. doi: 10.3390/jcm14144936.
The enzyme A Disintegrin and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) regulates hemostasis by cleaving von Willebrand factor (VWF) multimers. ADAMTS13-VWF axis dysregulation leads to different thrombotic conditions. This study investigated changes in ADAMTS13 activity during major cardiac procedures and their relationship to VWF changes and clinical complications. A total of 628 ADAMTS13 activity and inhibitor measurements were carried out in 168 patients who underwent cardiac surgery. ADAMTS13 activity was measured after the initiation of anesthesia and daily for up to 6 days postoperatively via Technozym chromogenic ELISA. The von Willebrand factor antigen (VWF:Ag) and collagen binding (VWF:CB) were also measured. Clinical complications and correlations with liver function biomarkers were also assessed. ADAMTS13 activity significantly decreased during surgery, with mean values markedly decreasing from preoperative to postoperative measurements ( = 0.01). A clear inverse relationship between ADAMTS13 activity and the VWF:CB/VWF:AG ratio was observed, indicating that increased high-molecular-weight VWF multimers are associated with decreased ADAMTS13 activity. Correlation analyses (CHE, Spearman's rho = 0.39) indicated that the reduction in ADAMTS13 activity was not attributable to impaired liver synthesis but likely resulted from peripheral consumption, potentially influenced by surgical stress. Perioperative reductions in ADAMTS13 activity are associated with an accumulation of high-molecular-weight VWF multimers and a higher incidence of postoperative complications. These results demonstrate that ADAMTS13 could be a useful perioperative risk biomarker for cardiac surgery patients.
具有血小板反应蛋白1型基序的解聚素和金属蛋白酶13（ADAMTS13）通过裂解血管性血友病因子（VWF）多聚体来调节止血。ADAMTS13-VWF轴失调会导致不同的血栓形成情况。本研究调查了心脏大手术期间ADAMTS13活性的变化及其与VWF变化和临床并发症的关系。对168例接受心脏手术的患者进行了总共628次ADAMTS13活性和抑制剂测量。在麻醉开始后以及术后每天最多6天通过Technozym显色ELISA法测量ADAMTS13活性。还测量了血管性血友病因子抗原（VWF:Ag）和胶原结合（VWF:CB）。还评估了临床并发症以及与肝功能生物标志物的相关性。手术期间ADAMTS13活性显著降低，平均值从术前测量到术后测量明显下降（ = 0.01）。观察到ADAMTS13活性与VWF:CB/VWF:AG比值之间存在明显的负相关关系，表明高分子量VWF多聚体增加与ADAMTS13活性降低有关。相关性分析（CHE，Spearman等级相关系数 = 0.39）表明，ADAMTS13活性的降低并非归因于肝脏合成受损，而是可能源于外周消耗，可能受手术应激影响。围手术期ADAMTS13活性降低与高分子量VWF多聚体的积累以及术后并发症的较高发生率相关。这些结果表明，ADAMTS13可能是心脏手术患者有用的围手术期风险生物标志物。
