Relations Between Coagulation-Fibrinolytic System And Pulmonary Artery Obstruction Index In Pulmonary Embolism

Objective:To investigate the change of PLT, FIB, D-D and FDP levels before and after treatment and the relationship between the change regularity and pulmonary artery obstruction index (PAOI) in pulmonary embolism (PE) patients, explore whether the coagulation-fibrinolytic system paratmeters can assess the PAOI and illness severity in PE patients, and provide theoretical evidences for treatment.Method:We conducted a prospective study on PE patients diagnosed by CTPA examination which named as PE group in 3 hospitals in Guangxi province from 1 Jan 2015 to 1 Jan 2016. The PAOI was assessed according to the Mastora scoring method. PE patients was divided into high, intermediate high, intermediate low and low risk groups base on the early mortality risk stratification of acute pulmonary embolism, and the PLT, FIB, D-D, FDP levels and PAOI were compared among the four groups. Dynamic changes of coagulation-fibrinolytic system parameters in 14 days treatment were monitored, and the relationships between these parameters and PAOI were also anlysed at pre- and post-14-days treatment.Results:A total of 34 patients in PE were enrolled from the three hospitals. There were 14 patients in low risk group,8 patients in intermediate low risk group,8 patients in intermediate high risk group and 4 patients in high risk group. With the increase of the early risk stratification of acute pulmonary embolism, the D-D and PAOI were increased (D-D levels were 6.27mg/L,9.16mg/L,11.47mg/L and 17.57mg/L for low, intermediate-low, intermediate-high and high risk group, respectively; PAOI were 19.17%,27.02%, 44.19% and 58.07%, respectively.). The change curve of coagulation-fibrinolytic system parameters within 14 days after treatment showed that PLT levels had been rising, FIB levels rised to the peak on the third day post-treatment and then decreased, D-D and FDP levels kept declining after treatment. PLT, FIB, D-D and FDP before treatment were significantly different from post-treatment at different days. It showed a negative correlation between PLT levels and PAOI before treatment (r=0.361, p=0.036). D-D levels pre-treatment, fourteenth day post-treatment and their variation were all positively associated with PAOI(r=0.530,0.580,0.523, respectively;p=0.001,0.000,0.002, respectively).FDP had correlation with PAOI only in 14 days variation before and after the treatment (r=0.424, p=0.012). FIB levels had no correlation with PAOI between pre-and post-treatment.Conclusion:D-D and PAOI can reflect the early mortality risk stratification of acute pulmonary embolism. The lower PLT levels and the higher D-D levels pre-treatment in PE patients indicate the degree of pulmonary artery obstruction is more serious. When the PLT levels keep rising, the D-D and FDP levels keep falling in PE patients after treatment, it suggests that pulmonary artery embolus is being dissolved, which means good prognosis.