Hemostatic System In Patients Research Articles

Diagnosis of hemostatic system disorders in patients with chronic heart failure using classical and integral methods

BACKGROUND: The state of the hemostatic system in patients with chronic heart failure (CHF) remains an insufficiently studied problem. PURPOSE OF THE STUDY: to present the results of an original study of the coagulation system of patients with CHF using an integral technique — low-frequency piеzothromboelastography (LPTEG). MATERIAL AND METHODS: The study involved 90 patients with CHF due to hypertension and coronary artery disease aged 50–75 years. The subjects were divided into groups with CHF I–IIa (n = 30), CHF stages IIb–III (n = 60). All patients underwent a study of the hemostasis system using classical (coagulogram) and integral (NPTEG) methods before prescribing antiplatelet and anticoagulant therapy. The comparison group consisted of healthy patients of the same age group without CHF (n = 30). RESULTS: In patients with CHF, a general blood test revealed a statistically significant decrease in the number of platelets (group 1 — 215; group 2 — 185) compared to the control group — 241. When analyzing the coagulogram, a decrease in the levels of prothrombin (group 1 — 89; group 2 — 86; control group 105), antithrombin-III (group — 76.5; group 2 — 73; control group — 91) and increased INR (group 1 — 1.03; group 2 — 1.12; control group 1.01) in patients in groups with CHF compared to the control group (p 0.05). When using the NPTEG method in patients with CHF, a decrease in indicators characterizing the rate of clot polymerization (intensity of clot polymerization) and clot density (maximum amplitude) was determined when compared with the control group (p 0.05). CONCLUSION: In patients with CHF, changes in the hemostatic system are determined, characterized by a tendency to hypocoagulation, the frequency a severity of which increases with the progression of the stage of the disease.

How to assess hemostasis in patients with severe liver disease.

Patients with advanced liver diseases frequently acquire profound alterations in their hemostatic system. Simultaneous changes in procoagulant and anticoagulant systems result in a reset in the hemostatic balance with a relatively neutral net effect, although there are notable hypocoagulable and hypercoagulable features in the hemostatic system in patients with liver disease. Laboratory and clinical studies have demonstrated that patients have a relatively well-preserved hemostatic system even though routine diagnostic tests of hemostasis (prothrombin time, platelet count) suggest a bleeding tendency. Routine diagnostic tests of hemostasis are unsuitable to assess the hemostatic status of patients with liver disease, as these tests are insensitive for the concurrent prohemostatic and antihemostatic changes in these patients. These tests are, however, frequently requested in patients with liver disease, as they are well established indicators of severity of liver disease. This paper will discuss commonly used diagnostic and research-type hemostatic tests and will outline how test results should be interpreted in patients with liver disease.

Effect of interval hypoxic therapy in the hypoxia-hyperoxia mode on the hemostatic system of patients who have suffered a new coronavirus infection COVID-19

Background. The positive effect of interval hypoxic therapy in the treatment of many diseases has become the basis for its use in rehabilitation after a new coronavirus infection to normalize disorders of the hemostatic system.
 Aim. To identify the peculiarities of the interval hypoxic therapy effect on the hemostatic system of patients who have suffered a new coronavirus infection.
 Material and methods. The work was carried out from April 2020 to May 2022. 220 men aged 4559 years (average age 48.82.4 years) were examined. The main group included 90 people who had a moderate coronavirus infection a month ago; the control group (n=70) was represented by relatively healthy people; the comparison group (n=60) suffered coronavirus infection and underwent standard rehabilitation without hypoxic therapy. The content of platelets, D-dimer, international normalized ratio, prothrombin time, activated partial thromboplastin time, antithrombin III activity, interleukin-6 level, and C-reactive protein content in the blood serum was determined. To assess statistically significant differences, a parametric method applying paired and unpaired Student's t-test was used. Differences were considered statistically significant at p 0.05.
 Results. In patients of the main group, a violation of the hemostatic system, indicating increased thrombogenicity of the blood against the background of persistent inflammatory activity, was revealed. After interval hypoxic therapy, the platelet count increased to 215.5323.57109/l (p=0.035), activated partial thromboplastin time to 26.741.84 s (p=0.035), international normalized ratio to 0.890.06 (p=0.005), antithrombin III activity in the blood up to 81.814.33% (p=0.007); the level of fibrinogen decreased to 3.861.09 g/l (p=0.035) and the content of D-dimer in the blood to 255.5817.36 ng/ml (p=0.035). There was a decrease in the level of interleukin-6 to 6.030.65 pg/ml (p=0.035) and C-reactive blood protein to 1.030.15 mg/l (p=0.035).
 Conclusion. Interval hypoxic therapy had a normalizing effect on the hemostatic system of patients who suffered a new coronavirus infection, as a result of suppressing the inflammatory process in the body.

The influence of prolonged high-adsorption membrane hemofiltration on the hemostatic system in patients with COVID-19

The objective was to evaluate the effects of prolonged (24–72 h) high-adsorption membrane hemofiltration on the hemostatic system.Materials and methods. A retrospective study included 91 patients with COVID-19 who received prolonged high-adsorption membrane hemofiltration (Prismaflex system) as part of complex therapy. The group was divided into two subgroups, taking into account the outcome of the disease. We analyzed the level of D-dimer, fibrinogen, platelet count, percentage of large platelets, thromboelastogram indicators, reflecting external and internal coagulation pathways (Intem, Extem) before and after the procedure. The levels of serine proteases (tPA, PAI) were additionally analyzed in 35 cases.Results. An increase in the D-dimer level, accompanied by a decrease in the fibrinogen concentration, was detected after sorption, which was especially noticeable in patients with unfavorable outcome (by 2.8 times). The thromboelastogram parameters after the procedure did not go beyond the normal range, the level of tPA and PAI became lower in both subgroups but there was no connection with the outcome.Conclusion. Prolonged high-adsorption membrane hemofiltration in COVID-19 patients does not have a negative influence on hemostasis system. A decrease in fibrinogen level after the procedure is associated with its mechanical removal from the circulation because of fibrin adhesion on the filter’s membrane and on sets’ walls; an increase in the D-dimer level should not be associated with the detection of degradation of fibrin networks.

Changes in the blood coagulation system in patients with chronic heart failure

The article provides a review of scientifi c publications dedicated to the study of the hemostatic system in patients with chronic heart failure (CHF). Russian and foreign authors evaluated the risks of bleeding and thrombosis in patients with CHF, as well as changes in the content of individual markers and factors of the coagulation system. The review suggests that the results obtained are quite contradictory. On the one hand, data is presented on an increased risk of thrombosis, changes in the content of some endothelial markers that promote endothelial thrombogenicity, an increase in the content of platelet aggregation markers, and elevated levels of fi brinogen and thrombin. On the other hand, there is data on an increased risk of bleeding in patients with CHF, an increase in some endothelial markers that enhance the anticoagulant properties of the endothelium. From the analysis conducted, it can be concluded that this topic is not suffi ciently studied, and it is diffi cult to judge the hemostatic potential in patients with CHF at present. The use of integrated methods such as thromboelastography (TEG) and low-frequency piezothromboelastography (LF-PTEG) are a promising direction for studying this problem. The results obtained using these methods will likely allow for a more precise understanding of the features of the coagulation system functioning in patients with CHF.

Pathophysiological Changes in the Hemostatic System and Antithrombotic Management in Kidney Transplant Recipients.

Nowadays, the main cause for early graft loss is renal graft thrombosis because kidney transplant outcomes have improved drastically owing to advances in immunological techniques and immunosuppression. However, data regarding the efficacy of antithrombotic therapy in the prevention of renal graft thrombosis are scarce. Adequate antithrombotic management requires a good understanding of the pathophysiological changes in the hemostatic system in patients with end-stage kidney disease (ESKD). Specifically, ESKD and dialysis disrupt the fine balance between pro- and anticoagulation in the body, and further changes in the hemostatic system occur during kidney transplantation. Consequently, kidney transplant recipients paradoxically are at risk for both thrombosis and bleeding. This overview focuses on the pathophysiological changes in hemostasis in ESKD and kidney transplantation and provides a comprehensive summary of the current evidence for antithrombotic management in (adult) kidney transplant recipients.

Disorders of the hemostatic system in patients with COVID-19 infection of varying severity

Aim to evaluate the individual characteristics of the hemostatic system and lungs CT-scan data in patients with a new coronavirus infection caused by the COVID-19, depending on the severity of the disease.
 Material and methods.A comparative analysis included the results of clinical, epidemiological and laboratory examination of 209 COVID-19 patients divided in two groups: in-patients of the Samara State Medical University Clinics with moderate (n=106) and severe (n=103) course of the disease. The diagnosis was verified by enzyme immunoassay (ELISA) and polymerase chain reaction (PCR). The following indicators were analyzed: gender, age, body mass index (BMI), epidemiological history, clinical signs of the disease, severity, degree of lung damage according to the results of computed tomography (CT).
 Results.There were no significant differences between the groups in terms of gender and age characteristics, as well as epidemiological data of COVID-19 patients. In 91% of patients with severe COVID-19, the clinical manifestations of hemorrhagic syndrome were recorded in the form of ecchymoses at injection sites, and in 75% - in the form of bleeding of various localization. The changes in the hemostatic system in patients with severe COVID-19 were characterized by high levels of platelets, INR, APTT, fibrinogen and a decrease in PI. In patients with severe COVID-19, a positive correlation was established between the level of fibrinogen, INR, APTT, PI and consolidation of lung tissue, as well as between the level of INR, APTT, PI and the presence of lung lesions in the form of "ground-glass" opacities on the CT images.

The characteristics of the hemostatic system in patients with external genital endometriosis

External genital endometriosis (EGE) is a common disease that substantially lowers quality of life in women. EGE is accompanied by chronic pelvic pain in 50% of cases. The role of the hemostatic system, proinflammatory factors, the complement system, and other biomarkers in the pathogenesis of EGE seems interesting. The literature describes an endometriosis-characteristic (local and systemic) condition of local and systemic hypercoagulation, activation of proinflammatory molecules, chemokines, and complement components. It is remarkable that after surgical removal of endometrioid foci, the biochemical and coagulation parameters return to normal. The objective of this review is to summarize the data on the diagnostic and prognostic significance of hemostatic factors, proinflammatory cytokines, cancer markers, the immunological and genetic panels within the framework of EGE

232 - The Effects of Plerixafor on Hemostatic System in Patients Undergoing Stem Cell Mobilization

232 - The Effects of Plerixafor on Hemostatic System in Patients Undergoing Stem Cell Mobilization

Hemostatic system in patients with endometrial hyperplasia and the risk of venous thrombosis: А literature review

While treating patients with endometrial hyperplasia, the physician may face both bleeding and thrombotic complications, particularly, during hormonal or surgical treatment, which significantly increases the risk of these complications. In addition, thrombotic complications in gynecological patients may result from congenital or acquired thrombophilia, blood flow disorders (blood stasis), and vascular wall damage, that is, the classic Virchow triad.
 This study aimed to review the recent scientific literature on the peculiarities of the blood coagulation system in patients with endometrial hyperplasia.
 The review reflects the results of studies conducted by Russian and foreign authors on the status of the blood coagulation system in patients with endometrial hyperplasia. The features of vascular, thrombocytic, plasma (procoagulant and anticoagulant), and fibrinolytic elements of hemostasis in these patients are considered. The data from the literature on the state of hemostasis before treatment and following hormone therapy and surgical treatment are presented. Moreover, the data of some studies on the genetic features of the hemostatic system in patients with endometrial hyperplasia are summarized. An analysis of the literature indicates the need for a careful choice of drugs and methods of treatment of these patients to avoid venous thromboembolic complications.

Immunological and hemostasiological aspects of pathogenesis of obliterating atherosclerosis of arteries of the lower extremities

Objectives to study the changes in the immunological status and hemostatic system in patients with obliterating atherosclerosis of the lower limb arteries with the damage to the femoral-popliteal-tibial segment.
 Material and methods. A comprehensive study of the cytokine status and hemostatic system in patients with obliterating atherosclerosis of lower limb arteries with lesions of the femoral-popliteal tibia segment was carried out.
 Results. The progressive course of obliterating atherosclerosis is often associated with an increased content of cytokines (IL-1, IL-6, IL-8, TNF), as well as with the phenomena of hypercoagulation (increased platelet aggregation activity, shortened APTT, CT, TT, increased fibrinogen content), SFMCs, D-dimer).
 Conclusion. The study of the immunological status and hemostatic system should be performed in all patients with obliterating atherosclerosis of the lower limb arteries in order to adequately medically correct and prevent postoperative complications.

Влияние общей анестезии на систему гемостаза у пациентов с морбидным ожирением

Актуальность. Пациенты с морбидным ожирением перед хирургическим лечением путем бариатрической хирургии должны пройти эзофагогастродуоденоскопию (ЭГДС), которая в основном выполняется с внутривенной седацией. Цель этого исследования — показать изменения данных низкочастотной пьезотромбоэластографии (НПТЭГ) от исходного уровня при поступлении до определенного уровня после ЭГДС. Материалы и методы. В исследовании участвовали пациенты в возрасте 25–45 лет с индексом массы тела ≥ 35 кг/м2, которым предстояло пройти лапароскопическую бариатрическую операцию (n = 58). Все пациенты не получали антитромботическую/антикоагулянтную терапию, не имели клинических признаков тромбоза ни в одном из сосудистых отсеков и должны были пройти предоперационную ЭГДС с седацией путем внутривенного введения пропофола 1%. Данные НПТЭГ собирали при поступлении и через 5 ± 3 мин после ЭГДС. Изменения гемодинамических параметров были в интервале 15,0 ± 3,2 %; целевые достигнутые уровни седации были 6c–7d по модифицированной шкале седации Рамси (MRSS). Результаты. Константами свертывания крови, проверенными НПТЭГ, были: интенсивность контактной коагуляции (ИКК), интенсивность стимуляции коагуляции (ИКД), максимальная плотность сгустка (MA) и фибринолитическая активность — индекс ретракции и лизиса сгустка (ИРЛС). При поступлении мы получили небольшое увеличение всех показателей в этой группе пациентов: ИКК — на 23, 57 %, ИКД — на 32,68 %, MA — на 74,52 %, ИРЛС — на 91,18 % выше нормы. Три пациента были исключены из-за необходимости искусственной вентиляции легких. После ЭГДС мы получили значительное увеличение всех показателей: ИКК — на 15,14 %, ИКД — на 36,35 %, MA — на 24,41 %, ИРЛС — на 27,61 % выше исходного уровня. Выводы. ЭГДС с седацией путем внутривенного введения пропофола 1% у больных с морбидным ожирением вызывает значительные изменения в данных НПТЭГ в сторону гиперкоагуляции. Дальнейшие исследования должны быть выполнены, чтобы установить этиологию этого процесса (изменения в гемодинамике и т.д.), создать алгоритм для данной процедуры в этой группе пациентов.

Activity of coagulation processes with comorbid hypertension and coronary heart disease

Purpose – determine the characteristics of changes of procoagulant, anticoagulant and fibrinolytic links of the hemostatic system in patients with hypertension in combination with coronary heart disease.
 Materials and methods. 127 people were examined - 14 healthy (control), 61 patients with stage II hypertension with concomitant coronary heart disease (group 2), 52 hypertensive patients with stage III with concomitant coronary heart disease (group 3). There were evaluated indicators of hemostasis system: thrombin time, activated partial thromboplastin time, prothrombin index, soluble fibrin monomer complex, fibrinogen, protein C, antithrombin III of, and the time of XII-dependent fibrinolysis.
 Results. Patients on both study groups SFMC content significantly higher than the control group. SFMC content in patients with stage II hypertension with concomitant coronary heart disease exceed normative value of 3 times, and in the group of hypertensive patients with stage III with with concomitant coronary heart disease of 3.65 times. The content of fibrinogen in the third group of patients exceeded the indicators of the control group by 27.6%, the difference was significant (p<0,001). Also valid was the difference between the two comparable groups (p<0,001). The content of protein C in hypertensive patients stage III was lower than the control values at 28,7% (p<0,001). The difference between comparable groups also were significantly (p<0,001). At the same time, and XII-dependent fibrinolysis in patients with stage II hypertension in combination with coronary heart disease was 3.54 times longer than the standard values (p<0,001), and the combination of hypertension III stage with CAD - 4.7 times longer than the norm (p< 0.001).
 Conclusions. Patients with hypertension stage II and III with concomitant coronary heart disease characterized by increased blood clotting activity in the background suppression of the anticoagulant and fibrinolytic components of hemostasis. The largest contribution to the formation of thrombophilic changes in patients of both treatment groups belongs to inhibition of fibrinolysis, which is more pronounced when hypertension stage III combined with coronary heart disease.

Assessment of systemic inflammatory reactions and coagulopathy against the background of hormonal therapy in covid-associated lung damage

The mechanisms of COVID-19-associated coagulopathy (CAC) are complex and differ in many ways from the standard mechanisms of thrombosis in critically ill patients. This review presents the pathogenesis, diagnosis, and comparison of various types of coagulopathy with SAS. During COVID-19 infection, the number of sudden deaths outside the hospital increased. One possible reason is the high incidence of serious thrombotic events in patients with COVID-19. However, the pathogenesis of these life-threatening events is multifactorial and requires independent discussion.Deviations in laboratory studies of the hemostatic system in patients infected with SARS-CoV-2 with a severe course indicate the activation of the blood coagulation system corresponding to sepsis-induced coagulopathy (SIC) or DIC. However, hemostasis disorders in COVID-19 have characteristics that distinguish them from DIC in sepsis.The clinical and laboratory features of CAC overlap with hemophagocytic syndrome, antiphospholipid syndrome, and thrombotic microangiopathy. The review presents data on their similarities and differences.Inadequate diagnosis or inadequate treatment of hypercoagulability may explain the high incidence of unexplained deaths from COVID-19. They can be associated with potentially preventable microvascular and macrovascular thrombosis and subsequent cardiovascular complications, including myocardial injury and infarction, as well as insufficient information content of biomarkers for their assessment.Research to identify the most informative biomarkers for decision-making to intensify anticoagulant prophylaxis in patients with severe COVID-19 is progressing rapidly, with increasing focus on TEG and ROTEM.The review presents changes in CAC during hormone therapy for COVID-19-associated lung damage. Pulse therapy with high doses of GCS has a rapid anti-inflammatory effect, but at the same time increases the level of D-dimer, which increases the risk of venous thrombosis and thromboembolism.

Hemostatic system in patients with cardiovascular implantable electronic devices

Hemostatic system in patients with cardiovascular implantable electronic devices

Effect of perioperative infusion therapy on the functional state of the hemostatic system in patients with concomitant coronary heart disease

Background. The choice of the infusion therapy regimen in the perioperative period remains a complex and controversial issue of modern anesthesiology. This is especially true for elderly patients with concomitant cardiovascular diseases, primarily coronary heart disease (CHD). Excessive fluid restriction in the perioperative period during the intervention can contribute to the development of arterial hypotension and hypoperfusion of vital organs. At the same time, excessive fluid intake in these patients is dangerous in terms of developing complications such as decompensation of heart activity, ischemic myocardial damage. There are many factors of the perioperative period that affect the processes of fluid metabolism in the body, the state of hemodynamics and other vital functions. Among them, the most significant factors are operational stress, features of the underlying disease and surgical intervention, the influence of anesthetics, the functional state of the cardiovascular system, kidneys, etc. One of the insufficiently considered factors that may influence the choice of infusion therapy, in our opinion, is the functional state of the hemostatic system in the preoperative period.
 Objective. To investigate the effect of perioperative infusion therapy on the functional state of the hemostatic system in patients with concomitant CHD.
 Materials and methods. A total of 92 patients who underwent abdominal surgery under combined general anesthesia with a ventilator were examined. The average age of patients was 61±12 years; risk on the ASA scale – II-III; risk of cardiac complications on the RCRI – 1-3; risk of thrombosis on the Caprini scale – 6.5±0.1. The functional state of platelets was assessed using the platelet aggregation analyzer AR 2110 (Belarus); the state of plasma hemostasis was assessed using standard coagulogram indicators.
 Results and discussion. When studying platelet aggregation in the initial state, significant fluctuations in the studied parameters were found from significant hypoaggregation to significant platelet hyperaggregation. For further analysis and differential correction, patients were divided into three groups depending on the degree of platelet aggregation. Group 1 included 22 patients with established hypoaggregation, 2nd group – 38 patients with established normal platelet aggregation, and 3rd group – 32 patients with platelet hyperaggregation. The coagulogram in the majority of patients in the initial state characterized normocoagulation or a tendency to hypercoagulation. Correction of changes in primary hemostasis was performed using infusion therapy, depending on the initial data of platelet aggregation. In the group with greegreece platelets was conducted infusion therapy with the liberal type – 5-10 ml/kg/h for intraoperative stage and 20-25 ml/kg/day after surgery; in the group with hoareau for restrictive type an average of 3-5 ml/kg/h for intraoperative stage and 20-25 ml/kg/day after surgery; in the group with normoergic the relatively restrictive type that was 5-7 ml/kg/h intraoperatively; 25 ml/kg/day after surgery. For specific correction of platelet-vascular hemostasis, etamzilate 12.5 % 4.0 ml was used in group 1 patients before surgery and later 4.0 ml three times a day; in group 3 patients, pentoxifylline 2 % 5.0 ml twice a day. Thromboprophylaxis with low-molecular-weight heparins in the perioperative period was performed in all patients according to current recommendations. As a result of this approach to the correction of established disorders of platelet-vascular hemostasis, a clear trend towards normalization of the studied parameters was established already at the intraoperative stage, this trend persisted a day after the operation. Thus, the indicators of platelet aggregation in group 1 patients at the intraoperative and early postoperative stages were 68.2 (59.5; 78.1) and 63.6 (60; 72.6); in group 3 patients – 79.7 (75.3; 94.2) and 74.6 (59.2; 83.4), respectively.
 Conclusions. Individualized infusion and pharmacological therapy allows correction of disorders of platelet-vascular hemostasis in patients with concomitant CHD, which may be useful for reducing the risk of thrombotic complications.

Pneumonia in pregnant women with COVID-19: is it a new thrombotic microangiopathy in obstetric practice?

Thrombotic microangiopathies during pregnancy and puerperium are rare and, if undiagnosed, can be life-threating conditions for both the mother and the baby. The aim of this review article is to briefly describe clinical profile and highlight the clues for a correct diagnosis of pregnancy-related thrombotic microangiopathies. Of particular interest and important practical significance are the presented data on changes in the hemostatic system in patients with a new coronavirus infection COVID-19 through the prism of thrombotic microangiopathies.

Особенности системы плазменного гемостаза у пациентов с новой коронавирусной инфекцией COVID-19

Aim To investigate plasma hemostasis in patients with different levels of COVID-19 severity Materials and methods The study included 46 patients with confirmed COVID-19, who were stratified into four groups based on disease severity as mild (1), moderate (2), severe (3), and critically severe (4) Laboratory investigations included APTT, Quick's prothrombin time, concentration of D-dimer, fibrinogen, ATIII, and platelet count Results D-dimer concentration >450 ng/ml was found in 100% of patients increasing from 973 (545–1635) ng/ml in group 1 to 13513 (7627–22512) ng/ml in group 4 (p 3633 ng/ml (specificity 92 3%, sensitivity 100%, AUC 0 94, p <0 001, positive predictive value 99 1%, and negative predictive value 100%) and ATIII <70 8% (specificity 70%, sensitivity 82 6%, AUC 0 85, p <0 001, positive predictive value 30 5%, and negative predictive value 96 1%) Conclusion The levels of D-dimer, fibrinogen, and ATIII were found to be associated with the severity of COVID-19

Possibilities of using hemostasis markers and parameters of hemostatic potential for predicting thrombotic complications in patients with CKD stage VD

Annotation. Violations in the hemostatic system of patients with chronic kidney disease (CKD) of the VD stage treated with program hemodialysis are associated with a high thrombotic risk. Comprehensive studies of the possible causes and predictors of thrombophilia can improve the therapeutic and prophylactic measures to combat thrombotic complications. The search for available methods for predicting these complications is very relevant. The goal is to develop a method for predicting the development of thrombotic complications in this category of patients, which would allow identifying the degree of hemostasis disorders. We examined 88 patients with CKD VD, treated with program hemodialysis, who determined the fibrinolytic potential and the level of soluble fibrin and D-dimer by enzyme immunoassay. It is proposed to use the developed fibrinolytic coefficient (Fc) to predict thrombotic complications. It was found that the proposed method for assessing hemostasis using Fc makes it possible to objectively characterize the state of the coagulation link and can serve as an indicator of thrombotic risk.

Cytokine status and features of the hemostatic system in patients with coronary heart disease

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