Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2021; 18 (3): 181-256 ➤ Оценка уровня естественных антикоагулянтов в алгоритмах диагностики состояния системы гемостаза у пациентов кардиохирургического профиля

Evaluation of the natural anticoagulants activity in diagnostic algorithms in cardiac surgery patients

Authors: Rogal’skaya E.A., Rybka M.M., Meshchanov B.V., Esayan G.S., Mumladze K.V., Samsonova N.N.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-3-231-240

UDC: 615.273.53:615.38:616.12-089.5-06

Link: Clinical Physiology of Blood Circulaiton. 2021; 3 (18): 231-240

Quote as: Rogal’skaya E.A., Rybka M.M., Meshchanov B.V., Esayan G.S., Mumladze K.V., Samsonova N.N. Evaluation of the natural anticoagulants activity in diagnostic algorithms in cardiac surgery patients. Clinical Physiology of Circulation. 2021; 18 (3): 231–40 (in Russ.). DOI: 10.24022/1814-6910-2021-18-3-231-240

Keywords:  natural anticoagulants antithrombin protein C protein S ischemic heart disease coronary artery bypass grafting pathology of the mitral valve

Received / Accepted:  30.03.2021 / 17.06.2021

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Abstract

Objective. To study the dynamics of the activity of natural anticoagulants depending on the variant of cardiac pathology in order to search for criteria for inclusion of patients in a cohort with an increased risk of developing intra- and postoperative thrombosis.

Material and methods. The study included 92 patients with a median age of 61 years (range 55; 66) with surgical correction of valvular heart disease, ischemic heart disease (IHD), or their combination under cardiopulmonary bypass. Research stages: before a skin incision, after suturing a surgical wound, 24 hours after the start of an operation; in patients with combined pathology, additionally – after a single dose of warfarin.

Results. All patients have a reduced preoperative antithrombin level, which is further reduced during surgical correction. In patients with pathology of the mitral valve (MVP), both isolated and in combination with IHD, an initially decreased protein C (PC) activity is observed. In accordance with the dynamics of the level of natural anticoagulants, the leading cause of the observed changes is a mitral valve disease. When MVP is combined with IHD, the most pronounced changes are observed: the maximum decrease of PC activity during an operation and not complete recovery by the end of the first operating day. After an administration of warfarin to patients of this study group, the dynamics of recovery is interrupted and the PC decreases again. At the same time, the activity of protein C and S does not reach critically low thrombogenic values.

Conclusion. Patients with a combination of MVP and ischemic heart disease need in a monitoring of an activity of natural anticoagulants to rationalize anticoagulant therapy. Taking into account the lack of results of critically low values of proteins C and S, as well as from the point of view of economic feasibility, to prevent a thrombosis of thin intervascular anastomoses in patients with a combination of MVP and IHD, it is important to include the study of antithrombin activity before surgery, intraoperatively and during the first postoperative days in the algorithm of clinical and laboratory assessment of the state of the hemostasis system.

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About Authors

  • Ekaterina A. Rogal’skaya, Cand. Med. Sci., Head of Hematology Laboratory; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology, Deputy Director of Bourakovsky Institute of Cardiac Surgery of Bakoulev NMRCCS; ORCID
  • Bair V. Meshchanov, Anesthesiologist-Intensivist; ORCID
  • Galina S. Esayan, Junior Researcher; ORCID
  • Koba V. Mumladze, Anesthesiologist-Intensivist; ORCID
  • Natal’ya N. Samsonova, Dr. Med. Sci., Professor, Chief Researcher; ORCID

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