To evaluate the parameters of the thrombin generation test (TGT) in coronary artery disease (CAD) patients on prolonged aspirin therapy during on-pump coronary artery bypass grafting (CABG) after donor platelet concentrate transfusion. A total of 148 patients with CAD on prolonged aspirin therapy (75–100 mg/day) who have undergone elective on-pump CABG were consecutively included in the study. Patients were divided randomly into two groups. Group 1 (n = 76) received donor platelet transfusions after cardiopulmonary bypass, whereas Group 2 (n = 72) did not. TGT parameters were measured using an analyzer at pre-, intra-, and early postoperative periods. Activation of the endogenous thrombin potential was observed in patients on prolonged aspirin therapy in the pre- and intraoperative periods, as confirmed by high peak thrombin and increased velocity index. The activation time of the prothrombinase complex and thrombin generation time were greater than the control group. The blood hemostatic potential in patients who did not receive transfusions in the early postoperative period decreased up to the level of the control group in the extended time parameters. Hemostatic potential in plasma in patients on aspirin was preserved. Given the laboratory test results and clinical data, platelet concentrate transfusion is unnecessary for prevention.
The hemostatic potential was preserved in patients receiving long-term therapy for ASA. Taking into account laboratory and clinical findings, platelet concentrate transfusions are unnecessary for preventive purposes. The appropriateness of donor platelet transfusion should be strictly individually approached with regard to the laboratory parameters of the thrombin generation test, by minimizing the risk of perioperative ischemic and hemorrhagic events in each specific patient.
Aim. To monitor the hemostatic system during platelet concentrate transfusions using low-frequency piezothromboelastography in patients with coronary bypass surgery given aspirin therapy. Materials and Methods. The study involved 148 patients with coronary bypass surgery, with 76 ones undergoing intraoperative transfusion of platelet concentrate and 72 treated without transfusion. The control group consisted of 20 healthy individuals. In the perioperative period indicators of vascular-platelet, coagulation, anticoagulant and fibrinolytic components of hemostasis were evaluated by low-frequency pezotromboelastography using the ARP-01M "Mednord" hardware and software system (Russia). Results. It was shown that the antiplatelet effect of aspirin in the preoperative period was manifest as inhibition of the initial stage of blood coagulation accompanied by increased thrombin potential, the total gain of anticoagulant and fibrinolytic activity of the blood. Heart-lung bypass was accompanied by structural and chronometric anticoagulation, reduction of anticoagulation and increase of blood fibrinolytic activity. In the postoperative period, structural and chronometric anticoagulation was more pronounced in patients who did not undergo transfusion of platelet concentrate than in the group of patients with transfusion. Donor platelets further increased the blood hemostatic potential by neutralizing the antiplatelet effect of aspirin. Perioperative thrombohemorrhagic complications were absent in both groups. Conclusion. Low-frequency piezothromboelastography provides a tool for real-time monitoring the functional state of hemostasis system. Transfusion of platelet concentrate is not advisable given that the thrombin potential is preserved as confirmed by the results of low-frequency piezothromboelastography.
3 Оригинальные и ОбзОрные статьиНа сегодняшний день по-прежнему важной за-дачей является изучение возможных механизмов прогрессирования ишемической болезни сердца (ИБС), развития инфаркта миокарда (ИМ) и его осложнений. Стратификация риска имеет большое значение для определения тактики ведения паци-ентов, перенесших ИМ. Высокий процент развития осложнений ИМ в ряде случаев является следствием недоучета важных патогенетических факторов, вли-яющих на течение и исход заболевания [4], поэтому актуален поиск новых маркеров риска развития не-благоприятного течения ИМ.Пусковым механизмом повреждения эндотелия сосудов, тромбообразования, нарушения гемодина-мики и трофических функций миокарда является дислипидемия. В этой связи нарушения липидного Цель исследования -оценка клинико-патогенетической значимости свободных жирных кислот при инфаркте миокарда (им) с подъемом сегмента st. Материал и методы. в исследование включены 133 пациента (возраст 60,25±1,12 года) с диагнозом им с подъемом сегмента st. в течение 30 дней после перенесенного им фиксировали конечные точки (острая сердечная недостаточность, нарушения ритма сердца, ранняя постинфарктная стенокардия), по наличию которых пациенты были разделены на группы осложненного и неосложненного течения им с последующим сравнением клинико-анамнестических и лабораторных данных обследования. Результаты. Нарушения липидного обмена независимо от нали-чия госпитальных осложнений характеризовались повышением концентрации атерогенных и снижением антиатерогенных фракций холестерола. содержание свободных жирных кислот в 1-е сутки у пациентов всех групп было выше относительно контроля, к 12-м суткам их уровень снижался, но оставался выше контрольных значений. При этом осложнения им ас-социировались с более высоким уровнем жирных кислот как на 1-е, так и на 12-е сутки. Заключение. среди показателей липидного профиля свободные жирные кислоты являются наиболее прогностически значимыми: высокие концентрации жирных кислот в госпитальном периоде увеличивают риск развития ранних осложнений им. Ключевые слова: инфаркт миокарда, свободные жирные кислоты, острая сердечная недостаточность, нарушения ритма сердца, ранняя постинфарктная стенокардия.Aim: to evaluate the clinical and pathogenetic role of free fatty acids in myocardial infarction-segment elevation st. Material and methods. the study enrolled 133 patients (aged 60,25±1,12 years) diagnosed with st elevation myocardial infarction. Within 30 days after myocardial infarction fixed development of acute heart failure, rhythm disturbance, early post-infarction angina. Depending on the availability of these complications, patients were divided into groups and then comparing the clinical history and laboratory survey data, which included a definition of traditional parameters of lipid and free fatty acids. Results. lipid metabolism is not dependent on the availability of hospital complications were characterized by increasing concentration of atherogenic and anti-atherogenic fractions of cholesterol reduction. the content of free fatty acids i...
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