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a:2:{s:4:"TEXT";s:133:"Effectiveness evaluation of conventional thromboprophylaxis in patients after univentricular repair by the thrombodynamics method ";s:4:"TYPE";s:4:"HTML";}


Authors: D.K. Gushchin, A.A. Kupryashov, M.M. Zelenikin

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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Heading: Original Research

UDC: 616.124.6-007.21:612.115.2

Link: Clinical Physiology of Blood Circulaiton. 2018; 2 (1): 16-23

Quote as: Gushchin D.K., Kupryashov A.A., Zelenikin M.M. Effectiveness evaluation of conventional thromboprophylaxis in patients after univentricular repair by the thrombodynamics method. Novosti Serdechno-Sosudistoy Khirurgii (Cardiovascular Surgery News). 2018; 2 (1): 16–23 (in Russ.).

Received / Accepted:  16.02.2018/20.02.2018

Full text:  


Abstract

Objective. Thromboembolic events take in one of the leading place in early and long-term mortality after the right heart bypassing. That is why choice of rational thromboprophylaxis after surgery is an extremely important factor. The aim of this study is to analyze influence of conventional thromboprophylaxis for time- and space-resolved indices of thrombin generation and fibrin clot growth in children after staged univentricular repair.

Material and methods.
A prospective analysis was undertaken of 18 patients in median age 26 months after staged univentricular repair. In the early postoperative period thromboembolic events were prevented by intravenous administration of heparin and warfarin or acetylsalicylic acid (ASA) were administration when transferring a patient to oral intake of food Combined thromboprophylaxis (heparin + warfarin/ASA) continued until reaching international normalized ratio (INR) within 2–3 for warfarin or within 24 hours after ASA administration. The collection and analysis of blood samples was carried out at the following endpoints: the initial state; postoperative, first day of heparin prophylaxis; second day of heparin prophylaxis; when the INR is reached within 2–3 for patients on warfarin prophylaxis or 48 hours after the start of ASA prophylaxis. The evalution of time- and space-resolved indices of thrombin generation and fibrin clot growth realized in Thrombodynamics Analyser (Hemacore LLC, Moscow, Russia). Statistical analysis of the results was carried out in the IBM SPSS Statistics program 22.0.

Results. Early prophylaxis with heparin significant suppressed (or tendency to suppress) the majority indices of thrombin generation and fibrin clot growth. When comparing the effects of ASA and warfarin there was a significant inhibition of thrombin generation by warfarin and no effect on thrombin generation by ASA. There was no significant influence of ASA on fibrin clot growth; there was significant inhibition or a tendency to suppress the majority of clot growth indices by warfarin. Hypocoagulation on heparin was achieved only in 38.9% of cases, ASA – in 27.3%, warfarin – in 14.3%. In the remaining cases, normo- and even hypercoagulation occurred.

Conclusions. The thrombodynamics method showed sensitivity not only to hypo-, but also to hypercoagulable states. The low frequency of hypocoagulation with conventional thromboprophylaxis in the early postoperative period determines the high risk of thromboembolic events and forms the necessity of reviewing the existing strategies of drug prevention of thromboses in this category of patients.

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About Authors

  • Gushchin Dmitriy Konstantinovich, Cardiovascular Surgeon, Research Associate, orcid.org/0000-0002-0925-6526;
  • Kupryashov Aleksey Anatol'yevich, Dr. Med. Sc., Senior Researcher of the Department, Chief of the Department, orcid.org/0000-0001-7673-4762;
  • Zelenikin Mikhail Mikhaylovich, Dr. Med. Sc., Professor, Chief оf Department, orcid.org/0000-0002-1298-2940

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