Objective To investigate plasma pro-and anti-coagulation factor activity of patients in the perioperative period of surgical correction for tetralogy of Fallot (TOF) and its clinical significance.
Methods From January 2010 to April 2013, 47 patients undergoing surgical correction for TOF in Southern Hospital of Southern Medical University were enrolled in this study. There were 35 male and 12 female patients with their age of 1.20-26.00 (8.00±6.48) years and body weight of 8.70-46.00 (18.20±21.50) kg. Preoperatively and on the 4th, 7th and 10th postoperative day, activity of plasma coagulation factor Ⅱ, Ⅶ, Ⅷ, Ⅸ and Ⅹ, and antithrombin Ⅲ (ATⅢ) and protein C levels of all the patients were routinely measured, as well as prothrombin time (PT) and activated partial thromboplastin time (APTT).
Results Activity of plasma coagulation factor Ⅱ (on the 4th postoperative day:102.66%±20.61% vs. 69.27%±16.51%), Ⅶ, Ⅷ, Ⅸ and Ⅹ(on the 4th postoperative day:125.43%±39.97% vs. 64.80%±11.46%) of TOF patients in the early postoperative period was significantly higher than preoperative level, reached the summit between the 4th and 7th postoperative day, and was still significantly higher than preoperative level on the 10th postoperative day. PT and APTT levels significantly decreased in the early postoperative period, and were still significantly lower than preoperative levels on the 10th postoperative day. Plasma AT Ⅲ and protein C levels were significantly increased in the early postoperative period but returned to preoperative levels on the 10th postoperative day.
Conclusions Preoperatively, haemostatic function of TOF patients is usually abnormal. Postoperative increased plasma procoagulant factor activity and recovered haemostatic function may be related to the correction of hypoxic state. In the early postoperative period, increased plasma procoagulant factor activity is helpful for haemostatic function. In the late postoperative period, an imbalance of provs anti-coagulation factors in plasma occurs towards stronger haemostatic function, which may increase the risk of thrombosis and render anticoagulant and antiplatelet therapy necessary.
Citation：
ZHANGZhen, LIQiang, WANGZhen-kang, HESheng-ping, DUSong-lin, WANJun, WANGWu-jun. Plasma Pro-and Anti-coagulation Factor Activity of Patients in the Perioperative Period of Surgical Correction for Tetralogy of Fallot and Its Clinical Significance. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 67-70. doi: 10.7507/1007-4848.20140018
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 1. 张振, 王武军, 王振康.法洛四联症患者围手术期凝血功能变化及意义.中国胸心血管外科临床杂志, 2009, 16 (3):244-245.
- 2. Goel M, Shome DK, Singh ZN, et al.Haemostatic changes in children with cyanotic and acyanotic congenital heart disease.Indian Heart J, 2000, 52 (5):559-563.
- 3. Auluck A, Manohar C.Haematological considerations in patients with cyanotic congenital heart disease:a review.Dent Update, 2006, 33 (10):617-618.
- 4. 王静, 沈立松.先天性心脏病患儿体外循环围术期凝血指标检测的临床意义.检验医学, 2006, 21 (3):272-275.
- 5. 于文, 李雪迎, 王宁华.不同氧分压对血液凝血特性的影响.中华物理医学与康复杂志, 2002, 24 (10):611-612.
- 6. Gutteridge JM.Biological origin of free radicals, and mechanisms of antioxidant protection.Chem Biol Interact, 1994, 91 (2-3):133-140.
- 7. Esmon CT.The roles of protein C and thrombomodulin in the regulation of blood coagulation.J Biol Chem, 1989, 264 (9):4743-4746.
- 8. Horigome H, Murakami T, Isobe T, et al.Soluble P-selectin and thrombomodulin-protein C-Protein S pathway in cyanotic congenital heart disease with secondary erythrocytosis.Thromb Res, 2003, 112 (4):223-227.
- 9. 楼金吐, 张泽伟.先天性心脏病患儿围体外循环手术期凝血与抗凝及纤溶水平的动态检测.临床检验杂志, 2000, 18 (3):183-184.
- 10. Petăjă J, Peltola K, Sairanen H, et al.Fibrinolysis, antithrombin Ⅲ and protein C in neonates during cardiac operation.J Thorac Cardiovasc Surg, 1996, 112 (3):665-671.
- 11. Boldt J, Knothe C, Welters I, et al.Normothemic versus hypothemic cardiopulmonary bypass:do change in coagulation differ? Ann Thorac Surg, 1996, 62 (1):130-135.
