The work is devoted to the study of the blood coagulation system and the correction of its indicators with a personalized anticoagulant target therapy in the early postoperative period to ten patients with implanted left ventricle assist devices for mechanical circulation support in the Silesian Center Heart Diseases, according to a bilateral agreement with the National Medical Academy of Postgraduate Education named after P. Shupik. The study included ten patients who were implanted in the Silesian Center for Heart Disease from March 11, 2016 to Nov 22, 2017, devices for mechanical support of left ventricular circulation LVAD in the aftermath of the terminal stage of heart failure.The subjects were men 55 ± 13.5 years old, with a body mass index of 30.8 ± 8.3 and a body surface area of 2.12 ± 0.2 m2 with a left ventricular ejection fraction of 15.4 ± 9.5%, which was mechanically supported blood circulation in the period from 11.03.2016 to 22.11.2017 in conditions of artificial blood circulation and combined endotracheal anesthesia, five of which had implanted cardioverts-defibrillators.Patients were divided according to the INTERMAKS Level 1 (cardiogenic shock) - 6 (60% of cases), Level 2 (progressive circulatory failure) - 4 men (40% of cases). Patients in the early postoperative period that time received an anticoagulant target mono and combination therapy with heparin (6-11U / kg / h), Aspirin (75-150mg.), Clopidogrel (75-150mg.), Warfarin (1.5-7mg), Nadroparinum Ca(0.3-0.6 ml / 2p / d), Fondaparinux Na (2.5-5 mg / 2p / d). The duration of support - POLVAD ranged from 102 to 156 days. Results - transplanted 2, died 2. The studies revealed a non-linear relationship between mortality, the number of days of general and intensive therapy for hospitalization, the use of extracorporeal membrane oxygenation and intra-aortic membrane oxygenation in patients with implanted systems of mechanical blood circulation, who used large doses of catecholamines during the postoperative period.Analyzing the needs of patients with implanted mechanical systems to support the blood circulation of the left ventricle in blood donations, it should be noted that in the early postoperative period the erythrocyte mass was most often used. During surgery, fresh-frozen plasma was the drug of choice, while the platelet mass was used in most cases during the pre-operative preparation of the patient.The main complications that developed in patients with implanted mechanical support systems of the left ventricular blood circulation were: bleeding, thrombosis of the mechanical blood circulation systems, cerebral circulation disorders due to hemorrhagic and ischemic type, infectious complications.
BLOOD COAGULATION SYSTEM AND PERSONALIZATION OF TREATMENT IN PATIENTS WITH IMPLANTED SYSTEM OF LEFT VENTRICLE ASSIST DEVICE IN THE EARLY POSTOPERATIVE PERIOD
