scholarly journals BLOOD COAGULATION SYSTEM AND PERSONALIZATION OF TREATMENT IN PATIENTS WITH IMPLANTED SYSTEM OF LEFT VENTRICLE ASSIST DEVICE IN THE EARLY POSTOPERATIVE PERIOD

2020 ◽  
pp. 43-48
Author(s):  
О. П. Мазуренко ◽  
П. Надзякевич ◽  
О. А. Лоскутов ◽  
Л. В. Згржебловська
Keyword(s):  
Left Ventricle ◽  
Blood Coagulation ◽  
Postoperative Period ◽  
Blood Circulation ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Coagulation System ◽  
Mechanical Support ◽  
Blood Coagulation System ◽  
Membrane Oxygenation

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.

scholarly journals Disorders of the Blood Coagulation System in Patients with Infectious Endocarditis

2021 ◽  
pp. 86-90
Author(s):  
Kostiantyn P. Chyzh ◽  
Hanna B. Koltunova
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Aortic Valve ◽  
Gastrointestinal Bleeding ◽  
Blood Coagulation ◽  
Anticoagulant Therapy ◽  
Postoperative Period ◽  
Infectious Endocarditis ◽  
Coagulation System ◽  
Blood Coagulation System

Infectious endocarditis is a disease which is still hard to diagnose and treat. The success of the proposed ther-apy depends not only on the surgical correction of the heart disease, but also on effective perioperative management of this group of patients. In most cases, patients have a long history of drug treatment and compromised status of all organs and systems. Coagulation disorders in patients with infectious endocarditis are one of the main links which lead to the patient’s death, despite advances in therapeutic and surgical treatment. Since the development of infectious endocarditis is based on thrombo-inflammatory lesions of the endocardium as a result of the interaction of microorganisms and modifiers of the blood coagulation system, the appointment of effective anticoagulant therapy in the postoperative period becomes one of the important tasks in resuscitation. The need to maintain balance between the coagulation and anticoagulation systems of hemostasis requires constant monitoring of the coagulation system and careful administration of anticoagulants. The aim. To demonstrate an example of an alternative scheme of anticoagulant therapy in a patient with postopera-tive gastrointestinal bleeding after cardiac surgery for infectious endocarditis. Materials and methods. We present a clinical case of treatment of acute gastrointestinal bleeding in the early post-operative period in a patient after cardiac surgery for infectious aortic valve endocarditis. The 56-year-old patient K. was taken to the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine by ambulance with a diagnosis: Infectious endocarditis of the aortic and mitral valves. Combined aortic defect with a predominance of insufficiency, mitral regurgitation, tricuspid insufficiency. Pulmonary arterial hypertension. Degree II respiratory failure. Ischemic heart disease: non-Q-wave myocardial infarction (as of October 29, 2020), RCA stenting (November 2, 2020), post-infarction atheroscle-rotic cardiosclerosis. Degree III hypertension, stage 2, risk 4. Heart failure 2B, functional class III. A salvage cardiac surgery was performed: aortic valve replacement. Mitral and tricuspid valve plastics. On day 2 of the postoperative period, against the background of anticoagulant therapy prescribed according to international recommendations, gastrointestinal bleeding developed. Anticoagulant therapy regimen was adjusted. The proposed scheme of hemostasis control allowed to normalize the blood parameters and to avoid blood loss. On day 10 of the postoperative period, standard scheme of anticoagulant ther-apy could be renewed, and the patient was transferred to the therapeutic department under the supervision of cardiologist. Conclusions. The proposed variant of anticoagulant therapy in the postoperative period in a patient operated on for infectious endocarditis created the conditions for normalization of hemostasis. Complete withdrawal of anticoagulants and transfer of patients to a continuous infusion of heparin under the control of APTT with a target value allows not only to control the risk of bleeding, but also to prevent thrombosis.

scholarly journals The use of enoxaparin as bridge to therapeutic INR after LVAD implantation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zubair Shah ◽  
Ioannis Mastoris ◽  
Prakash Acharya ◽  
Aniket S. Rali ◽  
Moghni Mohammed ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Index Admission ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Bleeding Events ◽  
Ventricular Assist ◽  
Safety Outcome

Abstract Background Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. Methods This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. Results Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07–6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27–3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31–2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. Conclusions LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR.

Thrombotic complications and changes in the hemocoagulation system in acute myocardial infarction

1982 ◽  
Vol 63 (5) ◽  
pp. 7-9
Author(s):  
L. A. Shcherbatenko ◽  
S. Z. Gabitov ◽  
I. E. Voronina ◽  
R. I. Litvinov
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Coagulation ◽  
Disseminated Intravascular Coagulation ◽  
Coagulation System ◽  
Blood Coagulation System ◽  
Maximum Activation ◽  
Great Vessels ◽  
Anticoagulant System ◽  
Thrombotic Complications

A natural relationship was revealed between the incidence of thrombotic complications and changes in the indicators of the blood coagulation system in patients with acute myocardial infarction. The totality of tests revealed two periods of maximum activation of the blood coagulation system, combined with inhibition of the anticoagulant system, on the 3-5th and 9-17th days of illness. These periods coincide with the time of the maximum incidence of thrombosis of the great vessels, disseminated intravascular coagulation and recurrence of myocardial infarction.

scholarly journals Changes in Indicators of Microcirculation in the Early Postoperative Period in the Treatment of Diaphyseal Fractures of the Shin Bones Using a Plate with Limited Contact

2019 ◽  
Vol 4 (3) ◽  
pp. 58-62
Author(s):  
A. I. Plakhov ◽  
L. I. Kolesnikova ◽  
L. I. Korytov ◽  
V. G. Vinogradov ◽  
M. A. Darenskaya
Keyword(s):  
Postoperative Period ◽  
Lower Limb ◽  
Blood Circulation ◽  
Early Period ◽  
Metal Plate ◽  
Early Postoperative Period ◽  
Control Group ◽  
Doppler Flowmetry ◽  
Results Of Treatment ◽  
Diaphyseal Fractures

Background. Unsatisfactory results of treatment, such as delayed consolidation and non-fusion of fractures, the formation of false joints and limb bone defects, have no tendency to decrease. We can assume that one of the leading factors of complications in traumatology is a violation of microcirculation in the affected segment of the limb.Aims. To identify patterns of changes in the parameters of the microcirculatory bed of the damaged segment of the lower limb when fixing bone fragments with a plate with limited contact in the early period after surgery.Materials and methods. In 25 patients, we studied four parameters of microcirculation of the lower limb segment with application of laser Doppler flowmetry. The control group consisted of 25 healthy volunteers, comparable in age and sex with the study group.Results. We found that in the early postoperative period (from the first to the 10th day after the surgery) in patients with diaphyseal fractures of the tibia operated with metal plate with limited contact there was an increase in microcirculation by 75.69 %, an increase in the proportion of the nutritive component of microcirculation compared to the shunt fraction by 24.64 %, as well as an increase in more than one ratio of the amplitude of the heart and respiratory range. All of that indicates a local circulatory disorder in the nutritive arterial hyperemia. We note that the increase in the amplitude of the respiratory component by 17.22 % and the equality of the amplitude of the cardiac range compared with the control group indicate violations of local blood circulation by the type of venous stagnation.Conclusion. On the basis of the results obtained, we note that patients with diaphyseal fractures of the shin bones treated with metal osteosynthesis with a plate with limited contact in the early postoperative period develop a violation of local blood circulation in the stagnant-hyperemic type.

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