Лабораторная оценка маркеров системы фибринолиза при операциях аортокоронарного шунтирования

Abstract

Introduction. Clinical manifestations of fibrinolysis are weakly expressed during coronary artery bypass surgery (CABS). The aim of study: to assess the possibility of biochemical markers usage for determination of fibrinolysis activation at various CABS stages. Materials and methods. We examined 40 patients with ischemic heart disease during myocardial revascularization surgery on working heart under cardiopulmonary bypass. Patients were divided into four groups; depending on applied antifibrinolytics three of them were denoted as «e-aminocaproic acid» («EAСА») group, «tranexamic acid» («TА») group and «aminomethylbenzoic acid» («AMBА») group. In fourth group antifibrinolytic was not applied, this group was used as a control. In all patients we examined markers level of hemostasis and fibrinolysis activation and registered tromboelastogram parameters (TEG). Results. We didn’t found any differences in activities of plasminogen and plasmin inhibitor, LY 30 parameter (in TEG) between groups. Inhibitor of plasminogen activator type I activity reduced from stage to stage of CABS in control group and consistently increased in study groups. We observed maximal increasing of D-dimer content in control group and minimal rising of D-dimer concentration in «TА» group. Conclusion. D-dimer level is the most informative laboratory marker of fibrinolysis activation. References Koster A., Faraoni D., Levy J. H. Antifibrinolytic Therapy for Cardiac Surgery: An Update. Anesthesiology. 2015; 123 (1): 214–21. Yavorovsky A. G., Zyulyaeva T. P., Charnaya M. A. Ee al. Efficacy and safety of tranexamic acid and e-aminocaproic acid in cardiac surgery in conditions of artificial circulation [Effektivnost’ i bezopasnost’ traneksamovoj kisloty i e-aminokapronovoj kisloty pri operaciyah na serdce v usloviyah iskusstvennogo krovoobrashcheniya]. Anesteziologiya i reanimatologiya. 2009; 4: 10–5 (in Russ.). Samsonova N. N., Andreev N. V., Klimovich.LG. Antifibrinolytic drugs in cardiosurgical operations with extracaporal circulation [Antifibrinoliticheskie preparaty pri kardiohirurgicheskih operaciyah s ekstrakoporal’nym krovoobrashcheniem]. Tromboz, gemostaz i reologiya. 2010; 1: 60–9 (in Russ.). Kuznik B. I. Cellular and molecular mechanisms of hemostasis regulation in norm and pathology: monograph [Kletochnye i molekulyarnye mekhanizmy regulyacii sistemy gemostaza v norme i patologii: monografiya]. Chita: Ekspressizdatel’stvo. 2010: 832 s (in Russ.). Ozolina A., Strike E., Jaunalksne I. et al. PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass. BMC Anesthesiol. 2012; 27. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3 524 048/. DeLoughery T. G. Coagulation defects in trauma patients: etiology, recognition, and therapy. Crit Care Clin. 2004; 20 (1): 13–24. Faraoni D., Willems А., Melot C. et al. Efficacy of tranexamic acid in paediatric cardiac surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2012; 42 (5): 781–6 Faraoni D., Rozen L., Willems A. et al. Experimental model of hyperfibrinolysis designed for rotational thromboelastometry in children with congenital heart disease. Blood Coagul Fibrinol. 2015: 26 (3): 290–7. Bokeria L. A., Kupryashov A. A., Kozar E. F. et al. Influence of the state of the fibrinolysis system on the development of perioperative bleeding in children after operations with artificial circulation [Vliyanie sostoyaniya sistemy fibrinoliza na razvitie perioperacionnyh krovotechenij u detej posle operacij s iskusstvennym krovoobrashcheniem]. Byulleten’ NCSSKH im. A. N. Bakuleva RAMN. 2011; 12 (5): 41–8 (in Russ.).