van Wersch J W, de Vries-Hanje J C, Oosterbos C
Thrombosis Centre, South East Limburg, The Netherlands.
Blood Coagul Fibrinolysis. 1994 Aug;5(4):605-8.
Twenty patients having routine laboratory control of oral anticoagulation after total hip or knee arthroplasty were consecutively included in the study and were anticoagulated at an International Normalized Ratio (INR) between 2.5 and 3.5. Patients with mechanical heart valve prostheses (n = 20), deep venous thrombosis or pulmonary embolism (n = 20), at the same level of oral anticoagulation, served as control groups. Plasma concentrations of prothrombin fragment 1 + 2 and D-dimer were measured and compared. In the mechanical heart valve prosthesis and deep venous thrombosis groups the median prothrombin fragment 1 + 2 concentrations were significantly lower than in the orthopaedic patient group (0.15 and 0.17 nmol/l versus 0.29 nmol/l). The D-dimer concentrations displayed a similar picture (150 and 200 micrograms/l versus 840 micrograms/l). The D-dimer/prothrombin fragment 1 + 2 ratios in the patients after total hip or knee arthroplasty were significantly higher (12.4) than in the control groups (5.3 and 6.0). These data show that the fibrinolysis/coagulation balance is enhanced, mainly due to a disproportional rise in D-dimer. After assessing when the D-dimer concentration returns to normal in this anticoagulated group, this parameter may indicate the appropriate duration of oral anticoagulant treatment after surgery for total knee or hip replacement.
本研究连续纳入了20例全髋关节或膝关节置换术后接受口服抗凝常规实验室监测的患者，其国际标准化比值（INR）维持在2.5至3.5之间。处于相同口服抗凝水平的机械心脏瓣膜假体患者（n = 20）、深静脉血栓形成或肺栓塞患者（n = 20）作为对照组。测定并比较血浆凝血酶原片段1 + 2和D - 二聚体的浓度。在机械心脏瓣膜假体组和深静脉血栓形成组中，凝血酶原片段1 + 2的中位浓度显著低于骨科患者组（分别为0.15和0.17 nmol/l，而骨科患者组为0.29 nmol/l）。D - 二聚体浓度也呈现类似情况（分别为150和200 μg/l，而骨科患者组为840 μg/l）。全髋关节或膝关节置换术后患者的D - 二聚体/凝血酶原片段1 + 2比值显著高于对照组（12.4）（对照组为5.3和6.0）。这些数据表明，纤维蛋白溶解/凝血平衡增强，主要是由于D - 二聚体不成比例地升高。在评估该抗凝组中D - 二聚体浓度何时恢复正常后，该参数可能表明全膝关节或髋关节置换术后口服抗凝治疗的合适持续时间。
