Hemodynamics, hemostasis and inflammation on the background of thromboprophylaxis with nadroparin calcium at elective abdominal surgeries

Abstract

Thombosis affects veins nearly in 3 times more often than arteries. In USA the one third of 150 000 - 200 000 VTE every year is connected with lethal conclusion after surgery [1].

Aim of research was to study an impact of presurgical start of thromboprophylaxis with nadrapirin calcium on hemodynamics, hemostasis and inflammation at the elective abdominal surgeries.

Matherials and methods. After informed consent 60 patients were prospectively separated into groups depending of preparation and regimen of thromboprophylaxis. The 1 group (n = 30) used UFH (5000 OD) for 2 hours before surgery on 5000 OD 2 times during 7 days after it. The 2 group (n = 30) used nadroparin calcium(«Fraxiparin»)9500 aXA IU(0,3 ml) for 2 hours before surgery on 2500 IU 1 time a day during 7 days after surgery. Patients were united on sex, age, contaminant pathology, class АSA (1-2) and type of surgical procedure (laparoscopic, cholecystectomy, hernioplasty). There were studied the number of trombocitises, prothrombin time, international normalized ratio (INR), activated partial thromboplastic time (APTT), fibrinogen, Х-а factor activity, antithrombin 111, prothein C, soluble fibrin monomeric complexes (SFMC) D-dimer before surgery and in 1 and 5 days after it.

Results and discussion: Administration of nadroparin calcium for 2 hours before surgery prolongs the time of clot formation from the first to fifth day at the expense of inhibition of the external way of coagulation. The risk of thrombotic complications decreases at administration of nadraparin calcium for 2 hours because of normalization of the level of protein C. At the same time the lysis of fibrin clots was accelerated on the background of nadraparin calcium.

At comparative characteristics we detected that an analysis of hemodynamic state at the standard thromboprophylaxis with UFH with output relatively normodynamic type of blood circulation that was formed by power-consuming, isometric, rhythm-depending mechanism was changed to relatively hyperdynamic type that was formed by homeometric, rhythm-depending and energo-exhausting mechanism at the 1 day of postsurgical period. At the 5 day of postsurgical period it was already of hypodynamic type that was formed by energo-consuming isometric mechanism. At the same time an output hypercoagulation and activation of fibrinolysis at the 1 day of postsurgical period on the background of UFH that was administrated in prophylactic doses was changed to an incomplete inhibition of an external way of blood coagulation, complete inhibition of an internal way of blood coagulation and partial inhibition of the general way of blood coagulation. Together with a stably low level of protein C it increased the risk of the development of thromboembolic complications in spite of hyperfibrinolysis. At the same time the output instability of inflammatory and antiinflammatory cytokines ratio at the first day of postsurgical period on the background of the standard thromboprophylaxis with UFH detected the prevalence of inflammatory processes over the antiinflammatory ones, this fact was confirmed by spasmodic growth of IL6. The tendency to decrease of activity of inflammatory processeses on the background of the growth of antiinflammatory ones was formed at the 5 day of postsurgical period.

An analysis of hemodynamic state at thromboprophylaxis with nadraparin calcium demonstrated that an output relatively normodynamic type of blood circulation that was formed by the energo-consuming isometric rhythm-depending mechanism at the first day after surgery was changed to normodynamic one with energo-exhausting homeometric mechanism and remained in this state until the 5 day of postsurgical period but with the mixed hetero-homeometric mechanism of compensation. Presurgical hypercoagulation on the background of activation of fibrinolysis system at the 1 day after operation was chaged to an inhibition of vascular platelet link of homeostasis, normalization of external and internal ways of of coagulation, tendency to normalization of the system of endogenic anticoagulants. An increase of fibrinogen level indicates not only an unsufficient blocking of the general way of coagulation but also the growth of inflammatory processes under influence of surgical trauma. At the 5 day after operation on the background of administration of prophylactic doses of nadroparin calcium the pathologic activation of the vascular platelet link of homeostasis, external and internal ways of blood coagulation, system of endogenic anticoagulants remained absent. At the same time in spite of significant activation of fibrinolysis the content of products of fibrin and fibrinogen degradation in the blood of patients remained high that formed conditions for development of thrombotic complications and an increased fibrinogen level can be explained by its direct correlative connections with an inflammatory IL10.

Conclusions: So nadroparin calcium before the surgical procedure ensure the reliable prolongation of the time of forming clot and acceleration of the lysis of fibrin clots, illiminates the risk of development of hemorrhagic complications and thrombotic complications until the 5 day that demonstrates an advantage of the use of an optimal regimen of thromboprophylaxis.