Intraoperative state of the hemocoagulation system in patients with open and endovascular revacularization of infraingual arterial segment in the presence of stenotic-occlusive process of tibial arteries
DOI:
https://doi.org/10.11603/2414-4533.2022.1.12913Keywords:
blood coagulation and aggregation system, revascularization, thrombosisAbstract
The aim of the work: to prevent thrombotic complications through vascular revascularization of the lower extremity using a pathogenetically reasonable system of postoperative thromboprophylaxis.
Materials and Methods. This study included 97 patients with atherosclerotic stenotic-occlusive process of the infrainguinal artery in terms of stenotic-occlusive lesions of the tibial arteries. In order to study the state of the hemocoagulation system on patients, methods were used to study the indicators of coagulation, fibrinolytic and aggregation systems.
Results and Discussion. The formation of hypercoagulable disorders in patients who used endovascular methods of revascularization of the arterial segment is more intense than in patients who performed open vascular revascularization methods. Hypercoagulation of blood at the intraoperative stage of revascularization occurs primarily due to the activity of factor II a of the hemocoagulation cascade. Given the above circumstances, already at the stage of completion of surgery for thromboprophylaxis should be prescribed – non-fractionated heparin (NFH). At the same time for the prevention of thromboembolic complications should be prescribed double anti-thrombocyte therapy: clopidogrel, acetylsalicylic acid.
Hypercoagulant ability of the blood system, which occurs after arterial reconstructive interventions occurs against the background of low activity of the fibrinolytic blood system, but with a gradual increase in the activity of the aggregation capacity of the blood. The formation of hypercoagulable disorders at the intraoperative stage of surgery in patients with endovascular methods of arterial reconstructions is more intense than in patients with open methods of arterial revascularization. Given these circumstances, already at the stage of completion of surgery for thromboprophylaxis should be prescribed an anticoagulant that has a targeted effect on factor IIa of the hemocoagulant cascade with simultaneous prevention of thromboembolic complications – double anti-thrombocyte therapy.
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