Disorders of the Blood Coagulation System in Patients with Infectious Endocarditis

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.

Changes in the blood coagulation system that determine postoperative complications in patients with non-tumor mechanical jaundice

The OBJECTIVE was to study the features of changes in the blood coagulation system that contribute to the development of postoperative complications in patients depending on the stage of non-tumor mechanical jaundice at admission.METHODS AND MATERIALS. A total of 537 patients with mechanical jaundice were examined and changes in the blood coagulation system were analyzed. Vascular-platelet hemostasis was characterized by the following tests: capillary resistance, the number of desquamated endothelial cells, the number of blood platelets. Plasma hemostasis was analyzed using activated partial thromboplastin time, plasma soluble fibrin level, thrombin time, prothrombin ratio, prothrombin index, and fibrinogen blood level. Then, XIIa-dependent fibrinolysis in the blood and the level of the fibrin D-dimer in the blood plasma were determined.RESULTS. It was found that in the first stage of mechanical jaundice, with cholestasis, there were no changes in blood coagulation system that go beyond the normal limits. In the second stage, during cytolysis of hepatocytes, hyperbilirubinemia and hypertransaminasemia contribute to the activation of platelet first, and then plasma hemostasis. In the third stage (cholangitis), the death of endotheliocytes increases and there is a deficiency of blood coagulation factors due to their consumption and increased fibrinolysis.CONCLUSION. In the stage of cholestasis in patients with non-tumors mechanical jaundice, the parameters of the coagulation system remain within the reference values. In the stage of cytolysis, as endotheliotoxicosis increases, platelet and plasma hemostasis begins to activate, which can lead to thrombosis and thromboembolism in vital organs. In the stage of cholangitis, further activation of plasma hemostasis causes hemorrhagic syndrome. The occurrence of the described disorders in blood coagulation system with the progression of MJ dictates the need to monitor the changes in the blood coagulation system and their correction for the prevention of intra-and postoperative complications.

ELEVATED IL-8 LEVELS AS A PREDICTOR OF HEMORRHAGIC DISORDERS IN PREMATURE INFANTS

The aim of the study was to find the relationship between changes in the level of interleukin 8 (IL-8) and changes in the main indicators of the blood coagulation system.

Linking Labile Heme with Thrombosis

Thrombosis is one of the leading causes of death worldwide. As such, it also occurs as one of the major complications in hemolytic diseases, like hemolytic uremic syndrome, hemorrhage and sickle cell disease. Under these conditions, red blood cell lysis finally leads to the release of large amounts of labile heme into the vascular compartment. This, in turn, can trigger oxidative stress and proinflammatory reactions. Moreover, the heme-induced activation of the blood coagulation system was suggested as a mechanism for the initiation of thrombotic events under hemolytic conditions. Studies of heme infusion and subsequent thrombotic reactions support this assumption. Furthermore, several direct effects of heme on different cellular and protein components of the blood coagulation system were reported. However, these effects are controversially discussed or not yet fully understood. This review summarizes the existing reports on heme and its interference in coagulation processes, emphasizing the relevance of considering heme in the context of the treatment of thrombosis in patients with hemolytic disorders.

MODERN PRINCIPLES OF MANAGEMENT OF WOMEN WITH ABNORMAL UTERINE BLEEDING, TAKING INTO ACCOUNT THE BLOOD COAGULATION SYSTEM STATE

Abnormal uterine bleeding in women of childbearing potential requires effective emergency care. To determine the features of disorders in the hemostasis system, 120 women were directly examined at the time of bleeding on admission to the hospital, during treatment on days 5−7 of the menstrual cycle, as well as after 6−12 months from the end of treatment. Determination of congenital and acquired defects of the hemostasis system became the main criterion for the selection of combined and isolated forms of abnormal uterine bleeding. Treatment measures for patients were etiopathogenetically selected and individually the intensity of bleeding, the degree of anemia, coagulation parameters were taken into account. The staged treatment involved stopping the bleeding, regulating the menstrual cycle and further preventing the bleeding. It has been found that uterine bleeding in reproductive age in the absence of etiopathogenetic treatment leads to the development of posthemorrhagic anemia. The severity and nature of bleeding is determined by the presence of defects in the platelet system of the hemostasis system with impaired platelet aggregation function. The study of total coagulation potential, primary hemostasis and the state of intravascular hemocoagulation in the patients using the methods for estimating the amount of platelet aggregation allows to detect and differentiate disorders in the hemostasis system. According to the results of the study, it can be concluded that the use of fibrinolysis inhibitors in the patients with abnormal uterine bleeding helps to increase the activity of the blood coagulation system and complete cessation of bleeding on the 2nd−5th day. Prophylactic administration of antifibrinolytic drugs from the first day of the menstrual cycle reduces blood loss, stabilizes menstrual function and significantly improves the psycho−emotional state of patients. Key words: abnormal uterine bleeding, blood clotting, fibrinolysis inhibitors.

Comparative Assessment of Changes in the Blood Coagulation System in Rats When Exposed to Organic Boron Compounds of Various Chemical Structures

Background. Despite the available information on the clinical manifestations of acute and chronic intoxication with boron compounds, no clear evidence was found among studies to research the effect of boron compounds with different chemical structures on key factors of the blood coagulation system. The data are presented in full for the first time. Aim of the study. Identification of possible signs of the effect of boron compounds on selected indicators of hemostasis in laboratory animals and their characteristics depending on the chemical structure of the compounds. Methods. Modern methods of studying hemostasis are used. Nonlinear rats were chosen as the experimental biological model. Once through the mouth, in the maximum tolerated dose, the following drugs were administered: isopropylmethacarborane, 1,2-di(oxymethyl)orthocarborane, 1,7-di(oxymethyl)methacarborane, polyethylammonium triethylammonium salt, boric acid. Research conducted against a background of dynamic control. Results. Materials were obtained that testify to the effect of boron compounds under the conditions of this experiment on factors of the blood coagulation system. The differences in this effect are established in connection with the chemical structure of the compounds, which are especially pronounced after the introduction of methacarboranes. The effect of orthocarborane and the polyethylammonium triethylammonium salt on factors was less significant. An important fact is that boric acid per se, by its effect on the blood coagulation system, turned out to be less effective than other compared compounds. Conclusion. The polytropy of the toxic effect of boron compounds of different chemical structures was confirmed, including with the involvement of the blood coagulation system, but with the essential features of each of them under conditions of a single exposure to laboratory animals in the maximum tolerated dose.

The consistent use of recombinant and plasma coagulation factors in the intensive care of massive obstetric hemorrhage

Massive obstetric hemorrhage is one of the most threatening complications of pregnancy, delivery and early postpartum period, which are part of the triad of leading causes of maternal mortality both in the world and in the Russian Federation. In recent years, to stop coagulopathy, which is one of the clinical manifestations of massive obstetric hemorrhage, recombinant and plasma factors of the blood coagulation system are successfully used, which include a concentrate of prothrombin complex and activated coagulation factor VII (eptacog alfa activated). The authors present results of successful consistent use of the blood coagulation system factors within comprehensive intensive care of coagulopathy in a patient with massive obstetric hemorrhage.