Iturbe T, Cornudella R, de Miguel R, Olave M T, Azaceta G, Varo M J, Moreno J A, Fuertes M A, Gutiérrez M
Servicios de Hematología y Traumatología, Hospital Clínico Universitario, Zaragoza.
Sangre (Barc). 1998 Oct;43(5):376-9.
Starting from a status hypercoagulability previous to substitutive hip and knee surgery, the aim of this work was to investigate the influence of different osteoarthropatic pictures for which arthroplasty is indicated in the activation of the clotting cascade, rheumatoid arthritis (RA) being one of such pictures.
Of 79 patients suitable for prosthetic surgery of hip (53) and knee (26), the preoperative values of several markers, namely, D dimers (D-D), thrombin-antithrombin (TAT) complex, and F1 + 2 prothrombin fragment (F1 + F2) were assessed by enzymoimmunoasay. The mean age of the patients was 65.5 years, and their sex distribution was 50 women and 29 men. The indications for arthroplasty were as follows: osteoarthrosis (62), aseptic necrosis (11), RA (9), articular gout (2), previous fracture (2), more than one diagnosis overlapped in some cases. The results attained were compared with a control group comprised of 33 subjects (16 women and 17 men) with mean age similar to the patient's group (68.06 years).
The D-D values in the patients suitable for hip arthroplasty and the TAT values in patients suitable for both types of surgery were significantly higher than those found in the control group (p = 0.012 and 0.01, respectively). The preoperative TAT levels of the RA patients were significantly higher (p = 0.025) than those found in the patients with the other surgical indications.
Previously to the performance of arthroplasty, the patients show hypercoagulative marker values higher than those of age-matched controls. The significant rising of TAT found in RA patients is concordant with the literature, and this fact makes it advisable to include RA among the pathologic situations associated with hypercoagulability, as this is a common indication for substitutive hip and knee surgery with high risk of venous thromboembolic disease.
鉴于髋关节和膝关节置换手术前存在高凝状态，本研究旨在探讨不同适合进行关节置换术的骨关节炎情况（其中类风湿关节炎（RA）是其中一种情况）对凝血级联激活的影响。
在79例适合髋关节（53例）和膝关节（26例）假体手术的患者中，通过酶免疫测定法评估了几种标志物的术前值，即D-二聚体（D-D）、凝血酶-抗凝血酶（TAT）复合物和F1 + 2凝血酶原片段（F1 + F2）。患者的平均年龄为65.5岁，性别分布为50名女性和29名男性。关节置换术的指征如下：骨关节炎（62例）、无菌性坏死（11例）、RA（9例）、关节痛风（2例）、既往骨折（2例），部分病例存在多种诊断重叠。将所得结果与由33名受试者（16名女性和17名男性）组成的对照组进行比较，对照组的平均年龄与患者组相似（68.06岁）。
适合髋关节置换术患者的D-D值以及适合两种手术类型患者的TAT值均显著高于对照组（分别为p = 0.012和0.01）。RA患者的术前TAT水平显著高于其他手术指征患者（p = 0.025）。
在进行关节置换术之前，患者的高凝标志物值高于年龄匹配的对照组。RA患者中TAT的显著升高与文献一致，这一事实使得将RA纳入与高凝状态相关的病理情况中是明智的，因为RA是髋关节和膝关节置换手术的常见指征，而此类手术具有静脉血栓栓塞性疾病的高风险。
