房间隔缺损介入封堵术后抗凝和抗血小板聚集的策略

The strategy of anticoagulation and anti-platelet aggregation after transcatheter closure of atrial septal defect again

目的:前瞻性评估房间隔缺损(ASD)介入封堵术后凝血和血小板系统的活化是否存在及程度,并提出新的抗凝策略。方法:选择单纯继发孔ASD导管介入封堵患者34例为试验组,另招募15名健康受试者为对照组。对照组随意设定假手术时间,两组病例均在术前1d、术后1、7、30、90、180d采血检查P-选择素和凝血酶原片段F1+2。结果:对照组F1+2的水平在整个试验过程中均无显著改变;试验组F1+2水平术后1d即明显升高至(1.49±1.01)nmol/L,与对照组(0.93±0.35)nmol/L相比有极其显著的统计学差异(P<0.01);术后7d试验组达到最高峰(1.59±1.02)nmol/L,与对照组(0.98±0.28)nmol/L相比有极其显著的统计学差异(P<0.01);术后30d试验组降至(1.09±0.48)nmol/L,仍高于对照组(0.85±0.32)nmol/L,但差异无统计学意义(P=0.05)。术后90d和180dF1+2水平无统计学差异(P>0.05)。对照组和试验组P选择素表达水平在任意时期均差异无统计学意义(P>0.05)。结论:凝血系统的显著激活最早在植入封堵器后的第1周就已经开始,30d时降至初始水平,而血小板活化系统却在任何时段均没有变化,因此建议重新制定术后抗凝标准。

Objective：To assess the existence and extent of blood coagulation and activation of platelet systems after transcatheter closure the ASD, propose a new anticoagulant strategies. Method：Thirty-four case with simple secundum ASD and accepted intervention closure therapy were included into experiment group,another 15 healthy subjects were included into control group. The control group underwent sham surgery any time. Both of the two groups were taken blood test in same day just before the procedure, and at 1, 7, 30 ,90 and 180 days after device implantation to examine the P-selectin and prothrombin fragment F1 ＋ 2. Result：The level of F1＋2 did not signifi- cantly changed throughout the experiment in control group. In experiment group, the level of F1＋ 2 increased to （1.49±1.01）nmol/L in the first day after operation, and reached to the peak of （1.59± 1.02） nmol/L at 7th day, then decreased to （1.09±0.48） at 30th day. The difference of F1＋2 levels at 30th, 90th, 180th between the two groups was no significant. The levels of P-selectin expression between the two groups had no significant difference at any time. Conclusion：The significant activation of coagulation system is begin at the first week after the occluder implanted, and decrease to initial level at 30th, while the platelet activation system does not change any more. So we recommend for re-enacting the anticoagulation standards after surgery.