Rodríguez Pinto M C, Fernández Urgellés M, Soto Ortega I, García Gala J M, Rosón Porto C, Corte Buelga J R
Servicio de Hematología, Hospital Central de Asturias, Oviedo.
Sangre (Barc). 1996 Feb;41(1):37-42.
To assess the incidence of congenital and acquired thrombophilia and to analyse the clinical characteristics of a group of patients with high risk criteria for thrombophilia.
Two hundred and eighty-five consecutive patients seen at the anticoagulant outpatient clinic of the Oviedo Central Hospital between 1987 and 1993 were evaluated. The patients had to meet one or more of the following: 1) venous thrombosis (VT) under 45 years of age; 2) repeat VT; 3) family history of VT; 4) unusual VT location (mesenteric, brain, etc.). The study was performed 4 to 7 months after the first acute episode and at least one month after suppression of anti-vitamin K treatment. The following test were carried out: blood cell counts, basic coagulation tests (APTT, PT, TT, RT and fibrinogen), lupus-like anticoagulant detection, with and without platelet extract, diluted tissular thromboplastin inhibition test, antibodies, anticardiolipin, liver and kidney functional screen, cholesterol, HDL, triglycerides and glycaemia. The venous occlusion test after 20-minute stasis was used for the global fibrinolysis study. The statistical evaluation was performed with the SPSS programme.
Biologic alterations were present in 98 patients (35%), 12% corresponding to congenital thrombophilia and 23% to acquired thrombophilia. The study was normal in 187 patients (65%). Of the patients with congenital thrombophilia, 4.9% had protein C (PC) deficit, 3.4% protein S (PS) deficit, and 2.4% antithrombin III (AT-III) deficit. Of the patients with acquired thrombophilia, 4.5% had antiphospholipid antibodies and 18% had impaired fibrinolysis. Of all the data analysed, the patient history was found of scarce predictive value as to the risk for thrombophilia. Significant differences were found for family history of VT (p < 0.0005) and for the association of more than one criteria for inclusion (p < 0.001).
No conclusions could be drawn from this study regarding the prophylactic attitude in patients with congenital abnormalities or anti-phospholipid antibodies. It is recommended to assess in such patients PC, PS and AT-III activities.
评估先天性和获得性血栓形成倾向的发生率，并分析一组具有血栓形成倾向高风险标准患者的临床特征。
对1987年至1993年间在奥维耶多中心医院抗凝门诊连续就诊的285例患者进行评估。患者必须满足以下一项或多项条件：1）45岁以下的静脉血栓形成（VT）；2）复发性VT；3）VT家族史；4）不寻常的VT部位（肠系膜、脑等）。研究在首次急性发作后4至7个月且在停用抗维生素K治疗至少1个月后进行。进行了以下检查：血细胞计数、基本凝血试验（活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、蝰蛇毒时间和纤维蛋白原）、狼疮样抗凝物检测（有无血小板提取物）、稀释组织凝血活酶抑制试验、抗心磷脂抗体、肝肾功能筛查、胆固醇、高密度脂蛋白、甘油三酯和血糖。20分钟静脉淤滞后的静脉闭塞试验用于整体纤维蛋白溶解研究。使用SPSS程序进行统计评估。
98例患者（35%）存在生物学改变，12%为先天性血栓形成倾向，23%为获得性血栓形成倾向。187例患者（65%）的研究结果正常。在先天性血栓形成倾向患者中，4.9%有蛋白C（PC）缺乏，3.4%有蛋白S（PS）缺乏，2.4%有抗凝血酶III（AT-III）缺乏。在获得性血栓形成倾向患者中，4.5%有抗磷脂抗体，18%有纤维蛋白溶解功能受损。在所有分析的数据中，患者病史对血栓形成倾向风险的预测价值不大。VT家族史（p < 0.0005）以及多种纳入标准的关联（p < 0.001）存在显著差异。
本研究无法就先天性异常或抗磷脂抗体患者的预防措施得出结论。建议评估此类患者的PC、PS和AT-III活性。
