Determination of the Level of Hypocoagulation to Change the Parameters of Microcirculation in the Treatment of Deep Vein Thrombosis

Abstract

Introduction - Venous thromboembolic complications are recognized as one of the main causes of death. The leading place in diagnosis of deep vein thrombosis (DVT) belongs to the colored ultrasound duplex screening (CDS). However there is no information in the periodical literature on the possibilities of the study of microcirculation (MC) at the height of DVT treatment with anticoagulants (AC), which could early recognize unsufficient level of hypocoagulation. Despite the widespread introduction of oral AC into clinical practice, the choice of clinicians is not always associated with their priority appointment, due to the risk of bleeding in special groups of patients, especially patients with reduced glomerular filtration rate. Timely determine the choice of AK and dosage, reliably providing a sufficient level of hypocoagulation is very important. Methods - There were examined in 98 patients with DVT of the lower limbs, confirmed by CDS, including 35 men and 63 women ranging in age 31 -89 and median age 65 years. In all patients, the thrombus was tightly fixed to the wall, had no signs of flotation. In the primary treatment has produced CDS with the determination of the level of occlusion. Parameters of MC were measured using high–frequency Doppler ultrasound "minimax-Doppler K" in the nail bed of the 1st finger of the upper limb by 15MHz ultrasound transducer. Analysis of dopplerograms was performed according to the shape and spectrum of curves. Control examination was performed after the appointment of AK therapy in 2, 4, 8 weeks. I group - 69 patients were prescribed rivaroxaban 15 mg twice a day for 3 weeks and then 20 mg a day, and II group - 29 patients with reduced glomerular filtration rate (lower than 50ml/min) recived rivaroxaban 20 mg for 3 weeks, followed by a transition to 15 mg a day. The obtained data were compared with the results of CDS – and percent of recanalizaton in dynamics. Results - In the evaluation of recanalization of thrombus in the I group in 1 month revealed an average of 64 % , in the II group an average of 50%, and 2 months from the start of treatment in the I group 78%, and in the second 56%. There is a tendency to a direct correlation of MC parameters and recanalization of the thrombus according to the CDS, due to the insufficient level of hypocoagulation with reduced dosage of rivaroxaban, which particularly affected the results of controlled after 2 months treatments. Conclusion - MC indicators correlate well with CDR data. The reduced dosage of rivaroxabane no soo effective as a full dose. Monitoring of the state of MC in patients with outpatient care allows during suspected insufficient level of hypocoagulation, which may be useful for further tactics of conducting these patients.