Coagulation-Fibrinolysis System and Postoperative Outcomes of Patients With Chronic Thromboembolic Pulmonary Hypertension
Coagulation-Fibrinolysis System and Postoperative Outcomes of Patients With Chronic Thromboembolic Pulmonary Hypertension
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DOI：
10.1253/circj.cj-15-1208
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发表时间：
2016-04-01
影响因子：
3.3
通讯作者：
Tatsumi, Koichiro
中科院分区：
文献类型：
--
作者：
Kato, Fumiaki;Tanabe, Nobuhiro;Tatsumi, Koichiro
背景资料：慢性血栓栓塞性肺动脉高压（CTEPH）患者接受肺动脉内膜切除术（PEA）后，凝血-纤溶系统的术后变化及其与术后病程的关系尚不清楚。1986年至2013年，117例患者（55.1 ± 11.2岁，术前平均肺动脉压46.5 ± 10.5 mmHg）接受了PEA，15例患者在围手术期死亡。我们研究了所有患者术前凝血纤溶标志物与手术结果之间的关系，以及102例PEA术后生存者的长期结果。我们还研究了20例连续患者术后凝血-纤溶标志物的变化及其与残余肺动脉高压（PH）的关系。只有因子VIII水平升高与围手术期死亡相关。血栓调节蛋白和纤溶酶原值显着增加后PEA。单变量logistic回归分析显示，随访时D-二聚体阳性是残余PH的危险因素。
Background: The postoperative changes in the coagulation-fibrinolysis system and the association between the system and postoperative course of patients with chronic thromboembolic pulmonary hypertension (CTEPH) who have undergone pulmonary endarterectomy (PEA) remain unclear.Methods and Results: Between 1986 and 2013, 117 patients (55.1+/-11.2 years, preoperative mean pulmonary arterial pressure 46.5+/-10.5 mmHg) underwent PEA, and 15 patients died during the perioperative period. We studied the association between the preoperative coagulation-fibrinolysis markers and surgical outcomes of all patients, and the long-term outcomes of the 102 survivors from the date of PEA. We also investigated the postoperative changes in coagulation-fibrinolysis markers and their association with residual pulmonary hypertension (PH) in 20 consecutive patients. Only an elevated factor VIII level was associated with perioperative death. Thrombomodulin and plasminogen values were significantly increased after PEA. Univariate logistic regression analysis revealed that D-dimer positivity at follow-up was a risk factor for residual PH. Patients with both an elevated fibrinogen level (>= 291 mg/dl [median]) and decreased plasminogen activity (