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/10.11603/1811-2471.2022.v.i4.13506Keywords:
blood coagulation system, aggregative assay, revascularization, complicationAbstract
SUMMARY. Open reconstructive interventions continue to occupy a leading place in the revascularization of multilevel atherosclerotic lesions of the arterial bed of the lower extremity. At the same time, the use of the proposed methods of revascularization (open, hybrid, endovascular) of the atherosclerotic stenotic-occlusive process of the femoral-distal arterial bed causes the development of a number of complications, among which the development of thrombosis of the reconstruction segment is diagnosed in 6–32 % of observations.
The aim – to prevent thrombotic complications through vascular revascularization of the lower extremity by using a pathogenetically reasonable system of postoperative thromboprophylaxis.
Material 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. 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 IIa 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.
Conclusions. Hypercoagulation’s 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 hemocoagulation cascade with simultaneous prevention of thromboembolic complications - double anti-thrombocyte therapy.
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