Character of changes of system of a hemostasis at sick of a cirrhosis

Authors

  • Алий Саитович Тугушев Zaporozhye state medical university; Sedov St., 3, Zaporozhye, Ukraine, 69035, Ukraine
  • Виталий Викторович Вакуленко Zaporozhye state medical university; Sedov St., 3, Zaporozhye, Ukraine, 69035, Ukraine
  • Ольга Степановна Черковская Zaporozhye state medical university; Sedov St., 3, Zaporozhye, Ukraine, 69035, Ukraine
  • Дмитрий Иванович Михантьев SD «Local clinical hospital on the station Zaporozhye-2 of the Pridneprovsky railway» Chumachenko St., 21, Zaporozhye, Ukraine, 69104, Ukraine
  • Вячеслав Васильевич Нешта SD «Local clinical hospital on the station Zaporozhye-2 of the Pridneprovsky railway» Chumachenko St., 21, Zaporozhye, Ukraine, 69104, Ukraine
  • Павел Иванович Потапенко SD «Local clinical hospital on the station Zaporozhye-2 of the Pridneprovsky railway» Chumachenko St., 21, Zaporozhye, Ukraine, 69104, Ukraine

DOI:

https://doi.org/10.15587/2313-8416.2015.43105

Keywords:

cirrhosis, hemostasis system, a koagulopatiya, thrombosis, a protein C, F VIII factor, dissemenirovanny intra vascular folding sindrom

Abstract

Since there were doubts as to the causes of hemorrhagic complications in liver cirrhosis it is actual a topical study both pro- and anticoagulant hemostasis.

Aim. To evaluate the hemostatic system in patients with liver cirrhosis.

Material and methods. 190 patients with cirrhosis were under examination: 123 have gastrointestinal bleeding, 67 - refractory ascites. 84 patients died during examination. The duration of examination was from 2-3 weeks to 2.5-3 years.

Estimation of procoagulant unit include determining the number of platelets, prothrombin index, activated partial thromboplastin time, blood-coagulation factor F VIII, fibrinogen levels, "B" and D-dimer fibrinogen. Anticoagulant system was evaluated by activity of coagulation inhibitor of protein C.

Results. In 71.5 % of discharged patients with bleeding and 60.0% of deaths, the activity of blood-coagulation factor F VIII exceeded normal levels. Increased activity of F VIII in patients with ascites was at 66.7% and 92.0%, respectively. In the dynamics of the percentage of patients with elevated F VIII in all groups increased, reaching 85.8 %–94.0 % (p<0.01).

The activity of protein C anticoagulant factor for 71.4% -88.0% of patients, which hospitalized with complications of LC, was reduced, accounting for less than 70%. Low activity of protein C remained in dynamics such as those discharged and deceased patients, 68.0% and 75.0%, respectively, at DH and 90.0% -94.0% - at ascites, (p <0.01).

Confirmation of the presence of thrombophilia in cirrhotic patients is to determine the level of D-dimer. At 75.0% -97.0% of patients hospitalized with complications of the LC, the content of D-dimer in serum at admission was 5-8 times higher among patients subsequently discharged and 8-12 times among the dead, not decreasing over time ( p <0,01).

Conclusions. 1. Hemostasis of compensated cirrhotic patients is characterized by an imbalance toward hypercoagulation, as evidenced by the decrease in the activity of protein C with normal or increased activity of blood-coagulation factor FVIII.

2. Decompensated patients have varying degrees of hypocoagulation severity characterized by laboratory thrombocytopenia, decrease of prothrombin index, fibrinogen, increase of APTT, production of fibrin degradation products (D-dimer), which clinically defines hemorrhagic syndrome in liver cirrhosis.

Author Biographies

Алий Саитович Тугушев, Zaporozhye state medical university; Sedov St., 3, Zaporozhye, Ukraine, 69035

Candidate of Medical Science, Assistant

Department of faculty surgery

Виталий Викторович Вакуленко, Zaporozhye state medical university; Sedov St., 3, Zaporozhye, Ukraine, 69035

Candidate of Medical Science, Assistant

Department of faculty surgery

Ольга Степановна Черковская, Zaporozhye state medical university; Sedov St., 3, Zaporozhye, Ukraine, 69035

Candidate of Medical Science, Assistant

Department of faculty surgery

Дмитрий Иванович Михантьев, SD «Local clinical hospital on the station Zaporozhye-2 of the Pridneprovsky railway» Chumachenko St., 21, Zaporozhye, Ukraine, 69104

managing surgical office

Вячеслав Васильевич Нешта, SD «Local clinical hospital on the station Zaporozhye-2 of the Pridneprovsky railway» Chumachenko St., 21, Zaporozhye, Ukraine, 69104

Candidate of Medical Sciences

doctor-intern of surgical branch

Павел Иванович Потапенко, SD «Local clinical hospital on the station Zaporozhye-2 of the Pridneprovsky railway» Chumachenko St., 21, Zaporozhye, Ukraine, 69104

attending physician of surgical office office

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Published

2015-05-28

Issue

Section

Medical