Postoperative changes in procoagulant factors after major surgery
Postoperative changes in procoagulant factors after major surgery
复制标题
大手术后促凝血因子的变化
DOI：
--
复制
发表时间：
2011
影响因子：
1.1
通讯作者：
B. Heindl
中科院分区：
文献类型：
--
作者：
S. Lison;Georg Weiss;M. Spannagl;B. Heindl
手术患者围手术期出血的风险主要增加；然而，手术后，这些患者发生高凝，有利于血栓事件。目前，术后凝血的时间过程还没有很好的表征。因此，本研究的目的是详细描述大手术后患者促凝因子的变化，并根据其检测高凝性的能力评估凝血试验。对51例连续接受不同类型大手术的患者进行分析。术前和术后第1、2、3、6天采集血样。除凝血酶原时间（PT）和活化部分凝血活素时间（aPTT）外，检测所有PT依赖性和aPTT依赖性凝血因子、血管性血友病因子（vWF）和纤维蛋白原，并进行凝血测定和多板电极聚集测定（MEA）。在POD 1中，大多数凝血因子，包括因子II、VII、X、XI和XII，均较基线显著降低。因子II、X、XI和XII在POD 3前仍显著降低。相反，从POD 2开始，纤维蛋白原、因子VIII和vWF持续增加。PT和aPTT未见相关变化。血栓测定显示血栓硬度持续增加，MEA显示POD 6上血小板聚集增加。然而，绝对值仍在正常范围内，只有连续测量显示高凝。从大手术后的POD 2开始，患者出现了明显的高凝。然而，临床使用的整体凝血试验和护理点设备并不能可靠地反映高凝状态。
Surgical patients are primarily at an increased risk of perioperative bleeding; however, after surgery, these patients develop hypercoagulability that favors thrombotic events. Currently, the time course of postoperative coagulation is not well characterized. Thus, the aim of the present study was to provide a detailed description of the changes in procoagulant factors in patients after major surgery and to evaluate coagulation tests based on their ability to detect hypercoagulability. Fifty-one consecutive patients undergoing different types of major surgery were analyzed. Blood samples were taken preoperatively and on postoperative days (PODs) 1, 2, 3, and 6. In addition to prothrombin time (PT) and activated partial thromboplastin time (aPTT), all PT-dependent and aPTT-dependent clotting factors, von Willebrand factor (vWF), and fibrinogen were obtained, and thrombelastometry and multiplate electrode aggregometry (MEA) were performed. On POD 1, the majority of clotting factors, including factors II, VII, X, XI, and XII, showed a significant decrease from baseline. Factors II, X, XI, and XII remained significantly reduced until POD 3. In contrast, starting on POD 2, fibrinogen, factor VIII, and vWF continuously increased. No relevant changes were found for PT or aPTT. Thrombelastometry revealed a continuous increase in clot firmness, and MEA demonstrated an increase in platelet aggregation on POD 6. However, absolute values remained within normal ranges, and only serial measurements showed hypercoagulation. Beginning on POD 2 after major surgery, significant hypercoagulability developed in patients. However, clinically used global coagulation tests and point-of-care devices did not reliably reflect the hypercoagulatory state.