Effect of Anticoagulant Treatment of Dabigatran and Warfarin on Hemostasis in Patients With Liver Cirrhosis and Atrial Fibrilation.

Abstract

The aim of this work. To evaluate and compare standard coagulation parameters and parameters of the low-frequency piezothromboelastography (LPTEG), global test of hemostasis assessment in patients with liver cirrhosis and atrial fibrillation before and after treatment with warfarin and dabigatran, as well as to determine the differences in parameters between patients of both groups.
 Material and methods. Stage I of the study was prospective, cross-sectional, II stage - randomized experimental study involving 70 patients (46 men and 22 women aged 42 to 83 years), who were divided at second stage into groups IA and received dabigatran at a dose of 110 mg 2g /d, and the IB group, who received warfarin at an initial dose of 5 mg for 3 months. Standard coagulation parameters and low-frequency piezothromboelastography data were assessed in comparison with treatment initiation and between groups. Statistical analysis was performed using the Excel for Windows software package and IBM SPSS Statistics.
 Results. After treatment with anticoagulant drugs, a statistically significant increase in the INR was revealed by 48.5% (p = 0.035), PT prolongation by 5.4% (p = 0.027) and thrombin time by 19.7% (p˂0.001) compared with initiation of treatment. Group IA showed a significant prolongation of APTT and TT parameters as compared to group IB (p˂0.01), while group IB had prolonged INR, PTI, PT and decreased fibrinogen levels (p˂0.05). According to the LPTEG data, in all patients, the t1 time was prolonged by 33.3%, the ICC index was decreased by 8% (p˂0.05), the CTA was decreased by 46% (p˂0.001), the coagulation time t3 was prolonged (p˂0.001) , parameters ICD, ICP, ITC, MA were significantly reduced by 26.7%, t5 was prolonged (p˂0.001), ICLR was reduced (p˂0.001) and CTAA was decreased by 10.3% (p˂0.001) compared with the beginning of treatment. Comparative analysis of IА and IB group of patients showed a statistically significant difference in all parameters of the LPTEG at the level of p˂0.001.
 Conclusions. Treatment with anticoagulant drugs had a greater effect on the laboratory values ​​of external and general coagulation pathways parameters and almost did not affect the platelet-vascular hemostasis initial stage, internal coagulation pathway and fibrinolysis system. According to the LPTEG data, the hemostatic potential (HP) of patients in group IB was characterized by a statistically significant shift towards hypocogulation after the treatment. A detailed analysis of the LPTEG parameters of group IA patients showed a decrease in the aggregation activity of blood cells and normocoagulative HP.