Dynamics of changes in the activation of blood coagulation tests at different variants of thromboprophylaxis
DOI:
https://doi.org/10.15587/2313-8416.2015.50208Keywords:
thromboprophylaxis, planned abdominal surgical interventions, hemostasis, fibrinolysis, hypocoagulation, hypercoagulation, thrombosisAbstract
Aim: To study an influence of the different variants of thromboprophylaxis on activation of blood coagulation test on the background of surgical aggression. D-dimer concentration in serum is in direct proportion to fibrinolysis activity and to an amount of lysed fibrin. At the same time fibrinolysis activation is followed with an increase of formation of products of fibrin degradation (PFD) that interact with fibrin-monomers and increase the number of SFMC.
Materials and methods: After informed consent 200 patients were prospectively divided into groups depending on preparation and regimen of thromboprophylaxis. 1 group (n=30) – ungraded heparin (UGH) (5000 ОD) for 2 hours before surgery 2 times during 7 days after it. 2 group(n=30) nadraparin calcium 9500 anti-Ха МO (0,3 ml) for 2 hours before surgery 2500 МО 1 time for a day 7 days after surgery; 3 group(n=48) – endoxaparin sodium(0,2 ml) for 2 hours before surgery 1 time a day 7 days; 4 group(n=29) endoxaparin sodium(0,2ml) for 8 hours before surgery, 0,2 ml 1 time a day 7 days; 5 group(n=34) – bemiparin sodium(0,2 ml) for 2 hours before surgery 0,2 ml 1 time a day 7 days; 6 group(n=29) bemiparin sodium(0,2ml) in 6 hours after surgery 1 time a day 7 days. Patients were comparable on sex, concomitant pathology, class АSA (1-2) and type of surgical intervention. There were studied the number of thrombocytes, prothrombin time (PT), INR AFTT, fibrinogen, Х-а factor activity, antithrombin, 111 (AT111), protein C, SFMC, d-dimer before surgery, on 1,5 and 7 day after it.
Results and discussions: On the 1 day of postsurgical period the most influence on D-dimer level had presurgical thromboprophylaxis (TPP) with UGH and nadroparin calcium. So the D-dimer level exceeded norm respectively by 67 % (р=0,017) and 65,9 % (р<0,05). In patients of 3 and 4 groups D-dimer level was the lowest that formed deficiency by 56 % (р<0,05) and 52,7 % (р<0,05) from the norm respectively. At the same time an analysis of patients with pre- and postsurgical start of TPP with bemiparin sodium detected the reliable exceed of D-dimer norm by 58 % (<0,05) for 5 group, by 24,3 % (р<0,05) – for 6 group. At the same time it was lower than D-dimer level of patients with TPP UGH by 5,3 % (<0,05) for 5 group and by 15 % (р<0,05) - for 6 group. The compensatory increase of SFMC level by- turn indicated an activity of thrombin in patients of 5 and 6 groups. SFMC level on 1 day after surgery in patients with TPP UGH exceeded SFMC level in patients of 5 and 6 groups, by 2,3 % (р<0,05) for 5 group, by 9,6 % (<0,05) – for 6 group. On the background of presurgical start of TPP with nadroparin calcium and 8-hour start of TPPH with endoxaparin sodium there was detected no reliable differences in SFMC level. At the same time on the background of presurgical 2-hour start of TPP with endoxaparin sodium SFMC exceeded norm by 9,2 % (<0,05), that was lower than TPP UGH by 12,8 % (<0,05) and exceeded TPP with nadroparin calcium by 13,8 % (р<0,05). On 5 day D-dimer level in patients of 1 group was the highest and exceeded norm by 142,9 % (р<0,05). In 2 group it reliably exceeded norm by 117,6 % (р<0,05), that hadn’t reliable differences from 5 group (HPP with bemiparin sodium started for 2 hours before surgery). D-dimer indicators in 3 and 4 groups were equal, lower than norm by 42,9 % ( р<0,05). SFMC level at TPP with bemiparin sodium exceeded norm by 52 % (р=0,013) and 47,7 % ( р<0,05) regardless of start without reliable difference between groups. In patients with TPP UGH SFMC indicators were not differ from the previous ones exceeding norm by 25 % (р=0,009) and decreasing from indicators of 4 group by 21,6 % (р<0,05). SFMC level in 3 and 4 groups had not reliable difference exceeding norm by 10 % (р=0,021). On 7 day of observance at TPH with bemiparin sodium with postsurgical start SFMC indicators were the highest that indicated the conservation of sufficient fibrinolytic activity at the given type of TPH. In patients of 1 group the SFMC level exceeded norm by 24,4 % (р<0,05), 3 and 5 groups by 9,7 % (р<0,05) and 14 % ( р<0,05).
Conclusions: At presurgical start of TPP UGH hemostasiological balance increased risks of development of thromboembolic complications (TEC) and bleeding from the 1 day of postsurgical period. Presurgical TPP UGH doesn’t eliminate the threat of TEC to the 5 day of postsurgical period. TPP with nadroparin calcium with presurgical start provide the normalization of hemostasiological balance already on the 1 day after surgery that minimizes the risks of thrombosis and bleedings. Presurgical start of TPP with endoxaparin sorium regardless of the beginning of injection of preparation increases risks of development of hemorrhagic complications in postsurgical period. TPP with bemiparin sodium at both pre- and postsurgical starts provide balance between formation and lysis of the clot that minimizes the risk of development of bleedings or TEC to 7 day of postsurgical period
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