Ito T, Tanouchi J, Kato J, Nishino M, Iwai K, Tanahashi H, Hori M, Yamada Y, Kamada T
Division of Cardiology, Osaka Rosai Hospital, Japan.
Angiology. 1997 Oct;48(10):901-6. doi: 10.1177/000331979704801007.
Venous thrombosis is a relatively usual but serious complication of permanent transvenous pacing. However, the pathogenesis has not been defined. To clarify underlying abnormalities in the coagulation-fibrinolysis system in patients with permanent transvenous pacemakers, we measured serum levels of fibrinopeptide A (FPA), thrombin-antithrombin III complexes (TATs), plasmin-alpha 2 plasmin inhibitor complexes (PICs), D-dimer (D-D), beta-thromboglobulin (beta-TG), and platelet factor 4 (PF4) in 53 patients with permanent transvenous pacemakers and 10 control subjects. The patients were divided into two groups, as follows, according to the presence of mural thrombus documented along the pacing lead(s) by digital subtraction angiography and transesophageal echocardiography: Group Th (-), patients without venous route thrombus; and Group Th (+), patients with venous route thrombus. FPA and TAT levels increased significantly even in Group Th (-), and further increased in Group Th (+) compared with control subjects (FPA: 7.5 +/- 4.9, 15.3 +/- 8.8 vs 3.0 +/- 1.4 ng/mL, respectively, P < 0.05; TAT: 2.9 +/- 1.3, 4.8 +/- 2.3 vs 1.7 +/- 0.6 ng/mL, respectively, P < 0.05). There were no differences in levels of D-D, PIG, beta-TG, and PF4 among control subjects, Group Th (-), and Group Th (+). These findings suggest that the hypercoagulable state appears in patients with permanent transvenous pacemakers, even without apparent venous thrombosis. The patients with permanent transvenous pacemakers are thought to be in the prethrombotic state even if they have no venous route thrombosis.
静脉血栓形成是永久性经静脉起搏相对常见但严重的并发症。然而，其发病机制尚未明确。为阐明永久性经静脉起搏器患者凝血-纤溶系统的潜在异常，我们检测了53例永久性经静脉起搏器患者和10例对照者的血清纤维蛋白肽A（FPA）、凝血酶-抗凝血酶III复合物（TATs）、纤溶酶-α2纤溶酶抑制物复合物（PICs）、D-二聚体（D-D）、β-血小板球蛋白（β-TG）和血小板因子4（PF4）水平。根据数字减影血管造影和经食管超声心动图记录的起搏导线沿线有无壁血栓，将患者分为两组：血栓组（Th(-)），无静脉途径血栓的患者；血栓组（Th(+)），有静脉途径血栓的患者。即使在Th(-)组，FPA和TAT水平也显著升高，与对照组相比，Th(+)组进一步升高（FPA分别为7.5±4.9、15.3±8.8和3.0±1.4 ng/mL，P<0.05；TAT分别为2.9±1.3、4.8±2.3和1.7±0.6 ng/mL，P<0.05）。对照组、Th(-)组和Th(+)组之间D-D、PIG、β-TG和PF4水平无差异。这些发现表明，即使没有明显的静脉血栓形成，永久性经静脉起搏器患者也会出现高凝状态。永久性经静脉起搏器患者即使没有静脉途径血栓形成，也被认为处于血栓前状态。
