THROMBOPHILIA, COMPLICATED BY ACUTE MYOCARDIAL INFARCTION: A CLINICAL CASE WITH THE ANALYSIS OF MODERN DIAGNOSTICS AND TREATMENT ALGORITHMS FOR THE MANAGEMENT OF PATIENTS
DOI:
https://doi.org/10.11603/1811-2471.2019.v0.i2.10450Keywords:
thrombophilia, myocardial infarction, diagnostics, treatmentAbstract
Diagnostics of thrombophilia and pathogenetic treatment of its clinical manifestations has a number of complications due to an asymptomatic or low-symptomatic course of illness and insufficient knowledge of doctors regarding the criteria for diagnosis of this pathology.
The aim of the study – to increase the level of diagnosis and the choice of adequate treatment for the patients with thrombophilia, complicated by acute myocardial infarction through the detailed analysis, clinical and laboratory analysis of our clinical case.
Material and Methods. System analysis, bibliosemantics and analysis of the case of a specific patient with thrombophilia, a study of genetic polymorphism associated with thrombophilia. The source search was carried out using the scientific statistical database of medical information: PubMed-NCBI.
Results and Discussion. In the absence of clear causative factors of high risk of acute myocardial infarction (stenotic atherosclerosis) and in the presence of recurrent thromboses of different localization, patients are recommended a compulsory examination to confirm (eliminate) congenital or acquired thrombophilia, which subsequently determines the program for the prevention of recurrent episodes of spontaneous thrombosis. For this purpose, a study of genetic polymorphism associated with the risk of thrombophilia in patients with recurrent venous (ileofemoral) and arterial (coronary) thrombosis was conducted. The most prognostic disadvantage was the presence in the patient of polymorphism of the 4G/4G alleles of the serpin-1 gene (RAI -1), an antagonist of the tissue plasminogen activator, which contributes in decreasing of fibrinolytic blood activity, which increases the risk of coronary disturbances in 1.3 times. At the same time, the patient was diagnosed with the polymorphism of the C/T alleles of the gene ITGA2 (integrin alpha-2), which is responsible for the function of the platelet receptor to collagen and contributes an increase in the platelet adhesion rate, which increases the risk of myocardial infarction in 2.8 times. It is also important to point out such a feature of genetic disorders in this patient, such as the polymorphism of the G/T alleles of the F13 gene, which is characterized in decreasing in blood coagulation factor VIII, which ultimately results in a reduction in the risk of venous thrombosis, but this risk can significantly increase in using of anti-coagulant therapy (12–20 %).
The obtained results substantiated the transfer of admission from xarelto (rivaroxaban) to the long-term use of direct low molecular weight heparins (fondaparinux) in such patient.
Conclusions. The obtained data indicate that in patients with diagnosed thrombophilia it is necessary to use a personified approach to the choice of antithrombotic agents and prevention of repeated thrombosis. Indications for the administration of direct or indirect anticoagulants are determined by the presence of a specific polymorphism of the gene and the form of thrombophilia in a patient.
References
Bondar, M.V. (2015). Do pytannia zapobihannia vynyknenniu nabutykh trombofilii u protsesi provedennia antykoahuliantnoi terapii [On the prevention of occurrence of acquired thrombophilia in the process of anticoagulation therapy]. Meditsina neotlozhnykh sostoyaniy – Medicine of Urgent States, 1, 99-105 [in Ukrainian].
Sushkevich, G.N. (2015). Trombogeneriruyushchie sistemy pri trombofiliyakh razlichnogo geneza [Thrombogenerating systems at thrombophilia of different genesis]. Meditsina neotlozhnykh sostoyaniy – Medicine of Urgent States, 6, 147-165 [in Russian].
Vasilyev, S.A. (2014). Trombozy i trombifilii [Thrombosis and thrombophilia]. Ostrye i neotlozhnye sostoyaniya v praktike vracha – Acute and Urgent States in the Practice of a Doctor, 1, 43-49 [in Russian].
Romanova, A.F., Vyhorska, Ya.I., & Lohynskyi, V.S. (2006). Hematolohiia [Hematology]. Romanova, A.F. (Ed.). Kyiv: Medytsyna [in Ukrainian].
Khan, S., & Dickerman, J.D. (2006). Hereditary thrombophilia. Thrombosis Journal, 4 (1), 15. DOI:10.1186/1477-9560-4-15. DOI: https://doi.org/10.1186/1477-9560-4-15
Kovalenko, V.M., & Lutai, M.I. (Ed.). (2011). Sertsevo-sudynni zakhvoriuvannia. Rekomendatsii z diahnostyky, profilaktyky ta likuvannia [Cardiovascular disease. Recommendations for diagnosis, prevention and treatment]. Kyiv: MORION [in Ukrainian].
Murin, S., Marelich, G.P., Arroliga, A.C., & Matthay, R.A. (1998). Hereditary thrombophilia and venous thromboembolism. American Journal of Respiratory and Critical Care Medicine, 158 (5) 1369-1373.https://doi.org/10.1164/ajrccm.158.5.9712022PubMed:9817680.
