| Autor: |
Owen, John, Kvam, David, Nossel, Hymie L., Kaplan, Karen L., Kernoff, Peter B.A. |
| Zdroj: |
Blood; March 1983, Vol. 61 Issue: 3 p476-482, 7p |
| Abstrakt: |
This study was designed to determine whether venous thrombosis is associated with a characteristic pattern in the plasma concentrations of fibrinopeptides and platelet alpha granule proteins. Patients undergoing elective craniotomy for tumor or vascular abnormality were studied prospectively for venous thrombosis with the 125I-fibrinogen uptake test and with daily measurement of the plasma concentrations of FPA (fibrinopeptide A), TIFPB (thrombin-increasable fibrinopeptide B reflecting Bβ 1-42), and βTG (β-thromboglobulin). Eighteen patients developed venous thrombosis and 14 did not. In the 14 patients who did not develop thrombosis, the mean FPA level was highest on the day after surgery and exceeded the TIFPB level so that the ratio of FPA to TIFPB, which is ≤0.5 in normals, was 1.2. During the next 14 days, both FPA and TIFPB levels were elevated, but the FPA/TIFPB ratio was not significantly different from the preoperative value. βTG and PF4 levels showed no clear pattern of change in the postoperative period. In 10 of the patients who developed thrombosis, the time of onset of thrombosis was documented by a change in the leg scan from negative to positive. In these 10 patients, the mean FPA level rose to equal the TIFPB level, producing an FPB/TIFPB ratio of approximately 1.0 for the 4 days preceding the change of the leg scan from negative to positive (p< 0.001). Changes in the βTG and PF4 levels were not statistically significant. We interpret the FPA and TIFPB levels as a distinct pattern that reflects sustained imbalance between thrombin and plasmin proteolysis of fibrinogen in association with the development of venous thrombosis. The finding of such sustained imbalance between FPA and TIFPB levels suggests that thrombosis is associated with impaired plasmin formation and/or action in addition to excessive fibrin formation. The finding that this pattern was evident several days before the leg scan became positive strongly supports efforts to develop a prognostic blood test. The blood tests used in this study showed adequate sensitivity, but low specificity for the detection of asymptomatic thrombosis. For this reason we suggest that use of these tests be confined to investigating the pathophysiology of thrombosis. |
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