Clinical Physiology of Circulation

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


Профилактика тромботических осложнений у больных с критической ишемией нижних конечностей

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Link: Clinical Physiology of Blood Circulaiton. 2011; (): -

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Abstract

Marked disorders of hemostasis and microcirculation in the patients with critical ischemia of lower extremities (CILE) due to atherosclerotic damage of the arteries are risk factors of early surgical thromboses. Alprostadil E1 (prostaglandin - PGE1) holds a specific place among the drugs affecting blood rheologic properties and some of the hemostasis system components. Alprostadil is a potent blocker of thrombocytes activation, improves microcirculation by increasing erythrocytes deformability, decreasing their aggregation and blood viscosity. PGE1 drugs have systemic positive effect on hemostasis. Material and methods. Comparative clinic-laboratory analysis of surgical results of two groups of patients with CILE due to atherosclerotic damage of the arteries was carried out. The main group comprised 140 patients who received complex treatment with alprostadil included, control group comprised 80 patients who received standard therapy pentoxifillin included. The study included the patients who had no technical errors on performing vascular anastomoses. Therefore we associated thromboses in the early postoperative period with hemostasiological reasons. Malleolar pressure index (MPI), transcutaneous pressure of oxygen, perfusion of foot skin and arterio-venous gradient as well as hemorheology and hemostasis values were studied. Results. Positive results were obtained in the main group in 92.9%, in the control group - in 75.0% patients. Early postoperative thrombosis developed in 7.1% patients in the main group and in 25.0% - in the control group, amputation at the foot and leg level in the main and control group were performed in 3.0 and 9.0% patients, lethality rate was 3.0 and 8.0% accordingly. Clinical results confirmed by the findings of instrumental and hemorheologic studies showed efficiency of alprostadil in the prevention postoperative thrombotic complications after vascular reconstructive interventions. Conclusion. Alprostadil application for surgical treatment of patients with CILE made it possible to reduce threefold the number of early postoperative thrombotic complications and reduce more than twofold postoperative lethality rate.

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