OPTIMIZATION OF ANTIPLATELET THERAPY IN PATIENTS WITH STABLE CORONARY HEART DISEASE COMBINED WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN STAGE OF STEATOHEPATITIS
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i1.8584Keywords:
stable coronary heart disease, non-alcoholic fatty liver disease, antiplatelet therapy.Abstract
Introduction. The indicator of cardiovascular mortality in case of non-alcoholic steatohepatitis (NASH) significantly exceeds the mortality rate from liver disease. It was established, that non-alcoholic fatty liver disease (NAFLD) was closely associated with the prothrombotic state, which was explained by the direct involvement of the liver in hemostasis.
Aim – to increase the effectiveness and safety of antiplatelet therapy (APT) in the complex treatment of patients with postinfarction cardiosclerosis combined with NAFLD in the stage of steatohepatitis.
Material and Methods. 211 patients with stable coronary heart disease (CHD) of II-III functional classes were examined. Among them 160 patients without NAFLD (Group I) and 51 patients with NAFLD in the stage of steatohepatitis (Group II) were observed. General clinical examination, electrocardiography, echocardiography, coronary angiography, liver ultrasound, evaluation of the liver functional state and platelet hemostasis were performed to all patients. Patients received a standard therapy in accordance with valid clinical protocols. The evaluation of treatment effectiveness was performed after 3 and 6 months of therapy.
Results. It was established that the efficacy of APT by platelets aggregative activity depends on the presence of NAFLD, the duration of treatment, the severity of liver damage on the background of NASH and, accordingly, the chosen pattern of differentiated APT. The sufficient effectiveness of APT was determined after 3 months of its use in patients with stable CHD without NAFLD. Instead, patients with stable CHD combined with NAFLD in the stage of NASH, required longer duration of platelet hemostasis correction with obligatory application of differentiated approach to APT according to the severity of liver damage.
Conclusions. The effectiveness of the influence on the platelet linkage of hemostasis by the platelet aggregation activity in patients with stable CHD depended on the presence of NAFLD and was more severe controlled in case of NASH. In patients with stable CHD combined with NAFLD in stage of steatohepatitis, it was expedient to control the effectiveness of APT every 3 months of its use and, if necessary, to make its correction, that involved consideration of the possibility of its strengthening or doubling, depending on the liver state.
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