华法令抗凝治疗初期依赖维生素K凝血因子活性的变化

The Variations of Vitamin K Dependent Factors at the Beginning of Oral Anticoagulant (Warfarin) Therapy (OAT)

目的:为探讨口服华法令抗凝治疗初期依赖维生素K凝血因子活性的变化规律及与凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)的相应关系。方法:选择20例机械瓣膜置换术的患者,在术后1 d开始服用华法令抗凝,分别于术前及术后1、2、3、5、9、13 d测定其血浆中凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ的活性及PT、APTT值。动态观察FⅡ、FⅦ、FⅨ、FⅩ活性及PT、APTT在其中的变化。结果:FⅡ、FⅦ、FⅨ、FⅩ活性术后第1 d显示低于术前组(P<0.05或P<0.01),而FⅨ:C活性明显高于服药前组(P<0.01);口服华法令后第1 d FⅦ:C明显低于服药前(P<0.05);FⅩ:C活性明显高于服药前(P<0.01);FⅡ:C、FⅨ:C从数值上看高于服药前但无统计学意义(P>0.05)。口服华法令后第2-4 d各凝血因子活性逐渐下降,与前一时间段比较差异均呈显著性(P<0.05或P<0.01))。服药后第8 d由于药物剂量的调整FⅦ:C、FⅨ:C有所回升。到服药后第12 d各凝血因子活性基本保持稳定。PT值随FⅦ:C的波动而随之相应改变。而APTT值服药后第1 d与术前比较无差异外(P>0.05),其余时间段均明显高于术前组(P<0.01)。结论:在口服华法令抗凝治疗初期,PT、APTT不能准确反映各凝血因子活性变化的水平,同时检测FⅡ、FⅦ、FⅨ、FⅩ活性。

Objective: To study the variations of vitamin K dependent factors at the beginning of OAT. Methods: Hematological assays included coagulation factors Ⅱ , Ⅶ , Ⅸ , Ⅹ and the prothrombin time ( PT) , the activated partial thromboplastin time (APTT)on 20 patients receiving OAT( warfarin)since day 1 after operation with mechanical prosthetic valves.Speciens were collected before operation and 1,2,3,5,9,13 day after operation and analyzed on the Sago-STA analyzer. Results:On day 1 the activity of FⅡ ,FⅦ ,FⅨ ,FⅩ declined ( P < 0.05 or P < 0.01) while FⅨ:C rised (P<0.01) clearly. On day 2 FⅦ:C declined (P < 0.05) while FⅩ:C rised (P<0.01) significantly compared with day 1. With regard to FⅡ :C,FⅨ:C,it shows no statistical significance.On day 3-5 it shows significant and gradual decrease (P < 0.05 or P < 0.01) in all coagulaiton factors. Until day 9, it showed rise in F Ⅶ: C,FⅨ: C. The activity of coagulation factrs became stabilized till day 13. The PT value of plasma may vary according to FⅦ :C, while APTT showed a high level than before operation ( P < 0.01)except day 7 (P > 0.05) . Conclusion: Its well known that the PT is commonly used for monitoring OAT( warfarin) because of its sensitivity to variations in the concentration of the vitamin K dependent factors Ⅱ , Ⅶ, Ⅹ , and the APTT may be associated with PT. But the PT and APTT is not accurate to the variations of vitamin K dependent factors at the begining of OAT (warfarin) . Consequently,the monitoring,in addition to PT and APTT,will necessitate the factors Ⅱ,Ⅶ,Ⅸ,Ⅹ to assess effects of OAT and to take the necessary adjustment measures.