Accelerated activation of the coagulation pathway during cardiopulmonary bypass in aortic replacement surgery: a prospective observational study.
Accelerated activation of the coagulation pathway during cardiopulmonary bypass in aortic replacement surgery: a prospective observational study.
复制标题
DOI：
10.1186/s13019-015-0295-9
复制
发表时间：
2015-06-23
影响因子：
1.6
通讯作者：
Sawamura S
中科院分区：
文献类型：
--
作者：
Sato H;Yamamoto K;Kakinuma A;Nakata Y;Sawamura S
任何形式的手术或组织损伤都会导致组织因子释放到血液循环中。这可能导致凝血因子的加速消耗，导致严重的消耗性凝血病。在这项研究中，我们比较了体外循环（CPB）中参与凝血激活的分子标记在主动脉置换手术和瓣膜手术患者之间的差异。这项前瞻性观察研究是在每14名接受主动脉置换手术或瓣膜手术的患者中进行的。我们评估了两组患者手术期间纤维蛋白原、活化因子VII （FVIIa）、凝血酶-抗凝血酶复合物（TAT）和可溶性纤维蛋白单体复合物（SFMC）水平的差异。纤维蛋白原水平的变化在两组之间没有差异。主动脉置换术患者TAT升高幅度远大于瓣膜手术患者（173.6 vs 49.4 ng/mL; p = 0.0001）。更重要的是，接受主动脉置换术的患者FVIIa升高明显更高（28.5 vs. 19.0 mU/mL; p = 0.0122）。在主动脉置换手术中，SFMC的增加幅度也更大。与瓣膜手术相比，主动脉置换术在CPB期间的凝血激活明显更高，这可能是由于前者激活了外源性凝血途径。这可能会加剧接受主动脉置换术的CPB终止后的消耗性凝血病，可能导致因止血受损而大出血。
Any form of surgery or tissue damage causes release of tissue factor into the circulation. This may lead to the accelerated consumption of coagulation factors, resulting in severe consumptive coagulopathy. In this study, we compared the molecular markers involved in coagulation activation during cardiopulmonary bypass (CPB) between patients who underwent aortic replacement surgery and those who underwent valve surgery. This prospective observational study was performed in each 14 patients who underwent aortic replacement surgery or valve surgery. We evaluated the differences in the levels of fibrinogen, activated factor VII (FVIIa), thrombin–antithrombin complex (TAT), and soluble fibrin monomer complex (SFMC) during surgery between these two groups. The change in fibrinogen levels showed no difference between the groups. The magnitude of increase in TAT was much larger in patients who underwent aortic replacement surgery than in those who underwent valve surgery (173.6 vs. 49.4 ng/mL; p = 0.0001). More importantly, the elevation of FVIIa was significantly higher in patients who underwent aortic replacement (28.5 vs. 19.0 mU/mL; p = 0.0122). The magnitude of increase in SFMC was also larger in the aortic replacement surgery. The activation of coagulation during CPB was dramatically higher in the aortic replacement surgery compared with the valve surgery, probably owing to the activation of the extrinsic coagulation pathway in the former. This could potentially exacerbate consumptive coagulopathy after CPB termination in patients who underwent aortic replacement, possibly resulting in massive hemorrhage due to impaired hemostasis.
登录
查看更多内容
影响因子：
9.8
作者：
Rahe-Meyer N;Pichlmaier M;Haverich A;Solomon C;Winterhalter M;Piepenbrock S;Tanaka KA
通讯作者：
Tanaka KA
影响因子：
4.6
作者：
Aldea, GS;O'Gara, P;Shemin, RJ
通讯作者：
Shemin, RJ
影响因子：
158.5
作者：
Roach, GW;Kanchuger, M;Mangano, DT
通讯作者：
Mangano, DT
影响因子：
20.3
作者：
Chandler, WL;Velan, T
通讯作者：
Velan, T
影响因子：
6
作者：
De Somer, F;Van Belleghem, Y;Van Nooten, G
通讯作者：
Van Nooten, G