López Y, Páramo J A, Valentí J R, Pardo F, Montes R, Rocha E
Laboratory of Vascular Biology and Thrombosis Research, University of Navarra, Pamplona, Spain.
Int J Clin Lab Res. 1997;27(4):233-7. doi: 10.1007/BF02912463.
Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre- and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1, 3, and 7. The following parameters were assessed: prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-alpha 2-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P < 0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P < 0.01) and a decrease in tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes was also observed early after operation. The plasminogen activator inhibitor activity decreased, while tissue plasminogen activator and plasmin-alpha 2-antiplasmin levels increased significantly on days 3 and 7 (P < 0.05). Fibrin degradation products significantly increased throughout the postoperative period (P < 0.01). Preoperatively, we found higher plasminogen activator inhibitor activity and lower tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes (P < 0.05) in patients undergoing hip replacement compared with abdominal surgery. Fibrin degradation products were also significantly lower on postoperative day 3 in patients undergoing hip replacement (P < 0.01). We suggest that the lower preoperative fibrinolytic activation observed in patients undergoing orthopedic surgery compared with abdominal surgery might have pathophysiological consequences. Our results also indicate that the hemostatic activation persists beyond the 7th postoperative day despite prophylaxis.
在未进行预防的情况下，接受腹部大手术的患者发生深静脉血栓形成的风险约为30%，而在骨科手术中该发生率在40%至60%之间。这种差异的原因尚未完全明确。本研究旨在比较接受低分子量肝素预防的两类手术患者术前和术后不同凝血及纤溶参数的变化情况。在手术前以及术后第1、3和7天采集样本。评估以下参数：凝血酶原片段1 + 2、凝血酶 - 抗凝血酶III复合物、纤维蛋白肽A、组织型纤溶酶原激活剂、纤溶酶原激活剂抑制剂、纤溶酶 - α2 - 抗纤溶酶复合物以及纤维蛋白降解产物。我们发现，与术前值相比，腹部手术和骨科手术后凝血标志物均显著升高（P < 0.05），表明存在明显的止血激活，这种情况一直持续到术后第7天。术后早期还观察到纤溶酶原激活剂抑制剂显著增加（P < 0.01），组织型纤溶酶原激活剂和纤溶酶 - α2 - 抗纤溶酶复合物减少。在术后第3天和第7天，纤溶酶原激活剂抑制剂活性降低，而组织型纤溶酶原激活剂和纤溶酶 - α2 - 抗纤溶酶水平显著升高（P < 0.05）。纤维蛋白降解产物在整个术后期间均显著增加（P < 0.01）。术前，我们发现与腹部手术患者相比，接受髋关节置换术的患者纤溶酶原激活剂抑制剂活性更高，组织型纤溶酶原激活剂和纤溶酶 - α2 - 抗纤溶酶复合物更低（P < 0.05）。接受髋关节置换术的患者术后第3天纤维蛋白降解产物也显著更低（P < 0.01）。我们认为，与腹部手术相比，骨科手术患者术前观察到的较低纤溶激活可能具有病理生理后果。我们的结果还表明，尽管进行了预防，止血激活在术后第7天之后仍持续存在。
