Soluble Fibrin Monomer Complexes Research Articles

Состояние гемокоагуляции у больных системной красной волчанкой на фоне пульс-терапии

Введение. Ревматические заболевания относятся к процессам, характеризующимся иммунным поражением различных органов и систем с выраженными изменениями сосудистой стенки и системы гемостаза. Цель исследования: изучить влияние высоких доз глюкокортикостероидов (ГКС) и цитостатиков на клинико-гемостазиологические показатели у больных системной красной волчанкой (СКВ). Материалы и методы. Обследовано 18 больных СКВ женщин (средний возраст — 35,6 ± 1,6 года), которые получали пульс-терапию ГКС и цитостатиком циклофосфаном по стандартной схеме. Критерии отбора для проведения пульс-терапии: высокая активность аутоиммунного процесса по шкалам SLAM, SLEDAI, ECLAM, поражение почек и центральной нервной системы. Гемостазиологические показатели исследовали до лечения, на 1-й и 14-й день после пульс-терапии. Для оценки состояния коагуляционного звена гемостаза определяли: активированное частичное тромбопластиновое время, тромбиновое время, протромбиновое время по Квику, содержание фибриногена, растворимых фибрин-мономерных комплексов, Д-димера, активность антитромбина III (АТ-III), протеина С, фибринолитической системы крови. Результаты. У больных СКВ наблюдали активацию коагуляционного гемостаза на фоне снижения активности естественных антикоагулянтов и процессов фибринолиза. На 1-е сутки после пульс-терапии выявлен значительный рост тромбинемии; к 14-у дню большинство показателей плазменного гемостаза возвращались к исходным на фоне снижения активности системы протеина С и роста активности АТ-III. Заключение. Исследование коагулологических параметров следует проводить всем больным СКВ, получающим пульс-терапию, так как существует угроза развития тромбозов у данных пациентов. Полученные данные подтверждают необходимость применения антикоагулянтов при назначении высоких доз ГКС и цитостатиков. Introduction. Rheumatic diseases are characterized by the immune damage of various organs and systems with expressed changes in the vascular wall and hemostasis. Aim: to study the eff ect of high doses of glucocorticosteroids (GCS) and cytostatics on the clinical and hemostasiological parameters in patients with systemic lupus erythematosus (SLE). Materials and methods. We examined 18 women with SLE of (average age — 35.6 ± 1.6 years) who received pulse therapy by GCS and cyclophosphamide according to the standard scheme. Selection criteria for pulse therapy were high activity of the autoimmune process according to SLAM, SLEDAI, ECLAM scales, kidney and central nervous system damage. Hemostasiological parameters were investigated before treatment, on the 1st and 14th days after pulse therapy. To assess the state of coagulation hemostasis, we determined: activated partial thromboplastin time, thrombin time, Quick prothrombin time, fibrinogen content, soluble fi brin-monomer complexes, D-dimer, activity of antithrombin III (AT-III), protein C, fibrinolytic system. Results. In patients with SLE, activation of coagulation hemostasis was observed with the reduction in the activity of natural anticoagulants and fi brinolysis processes. On the 1st day after pulse therapy, a signifi cant thrombinemia growth was detected; by the 14th day, most of plasma hemostatic parameters returned to baseline with reduction of protein C system activity and increasing of AT-III activity. Conclusion. The study of coagulological parameters should be carried out in all patients with SLE who receive pulse therapy, since there is a risk of thrombosis in these patients. The obtained data confirm the need for anticoagulants use in the appointment of high doses of GCS and cytostatics.

Effect of L-arginine Aspartate on Plasma Hemostasis in Patients with Hypertension Stage II with Concomitant Hyperuricemia

The prevalence of hypertension is increasing in many countries and is an important risk factor for cardiovascular morbidity and mortality. The established risk factors for hypertension include aging, dyslipidemia, and diabetes. Recently, the role of an increased level of uric acid as a risk factor for atherosclerosis, endothelial dysfunction, and hypertension has been actively studied.The objective: аnalysis of L-arginine aspartate on the parameters of plasma hemostasis as a hemostasiological component, which reflects the severity of endothelial dysfunction in patients with hypertension stage II with concomitant hyperuricemia.Materials and methods. We examined 74 patients (43 males and 31 females), whose average age was 55,86±6,34 years, all patients were divided into 2 groups. The first group consisted of 26 people with arterial hypertension with normal uric acid levels, the second group consisted of 34 people with hypertension and concomitant hyperuricemia, and the control group consisted of 14 healthy individuals matched for age and sex.Results. When treating L-arginine aspartate, fibrinogen level decreased by 17,9% (p=0,05) in hypertensive patients and by 25,4% (p<0,001) in hypertensive patients with concomitant hyperuricemia, thrombin time increased in patients I groups by 40,2% (p<0,001), in group II by 65,8% (p<0,001), an increase in soluble fibrin monomer complexes is observed in all groups of patients: in the group of hypertensive patients without hyperuricemia by 39,2% (p<0,001), with combined pathology by 34,6% (p<0,001) in comparison with the baseline indicators of these patient groups. On the part of the anticoagulant system, we observed an increase in the level of antithrombin III by 27,3% (p<0,01) in hypertensive patients and by 23,4% (p<0,01) in patients with combined pathology, an increase in the level of protein C by 8,99% (p<0,05) in group I patients and 11,26% (p<0,01) in group II patients. Indicators of the fibrinolytic system of blood such as Hageman-dependent fibrinolysis decreased by 33,8% (p<0,001) in group I of patients and by 32,1% in group II of patients, plasminogen in group I increased by 22,6% (p<0,01) and in group II by 27,8% (p<0,001).Conclusion. The use of L-arginine aspartate in patients with hypertension stage II in combination with hyperuricemia, as a secondary prevention, provides improved plasma hemostasis and has an indirect effect on the activity of inflammation as a component of the cardiovascular continuum.

PROTHROMBOTIC STATES IN WOMEN WITH INFERTILITY AND PSYCHOSOMATIC DISORDERS

Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA).The aim of the study was to establish the value of antiphospholipid antibodies in the effectiveness of infertility treatment by assisted reproductive technologies in women with psychosomatic disorders.Material and methods. 93 women with infertility were screened: 1 group - 32 women without severe psychosomatic disorders; group 2 - 61 women with psychosomatic disorders. The control group consisted of 30 fertile women.Results. Definition in the blood serum of the level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time - APTT, D-dimer), homocysteine, molecular genetic study of polymorphous variants for β-fibrinogen (C148T, -455GA) genes. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and if they were present - 44.3%, respectively. Only in 11.5% of women in 2 groups, elevated levels of APA were associated with one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels. Some patients have hyperhomocysteinemia. In patients with psychosomatic disorders, the frequency of the minor alleles of the locus C148T and -455GA of the β-fibrinogen gene was greater than 40% (25-30% in group 1).Conclusions. Allocated factors that adversely affect the efficiency of IVF at the patients with psychosomatic disorders: elevation of APA; reduction in the number of platelets; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine; the presence of the minor allele of the T polymorphic locus C148T of the β-fibrinogen gene. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and make the appropriate correction for them.

Characteristics of Violations in the Aggregate State of Blood Regulation System of Women with a High Degree Anemia on the Background of Endometrium Hyperplastic Processes

Endometrial hyperplasia is a benign pathology of the uterine mucosa, characterized by certain histological changes, characterized as simple and complex, non-atypical and atypical forms. Hyperplastic processes of endometrium, according to various authors, in the structure of gynecological pathology make up 15 to 40%. Clinically, the endometrial hyperplasia manifest by uterine bleeding. Maternal bleeding that is not susceptible to hormonal, symptomatic, and hemostatic therapy, leads to chronic post-hemorrhagic anemia and is the indication for surgical intervention. Consequently, systemic disorders of the hemostasis parameters on the background of uterine bleeding with endometrial hyperplasia, in particular the regulation of the aggregate state of blood systems, require further research to identify new pathogenetic links and develop correction methods.Materials and methods.State of platelet-vascular hemostasis was assessed by the percentage of platelets adhesion in the blood and by the index of spontaneous platelet aggregation. Total potential coagulation of blood, plasma fibrinolytic activity, plasminogen potential activity, antiplasmin, fibrinogen in blood plasma, the activity of antithrombin III, the concentration of soluble fibrin monomer complexes in the blood was determined by reagents made by Simko Ltd company (Ukraine). Using the «Thromboelastohraph ACG» machine we identified parameters of thrombin clotting rate, thromboelastograph K constant, specific platelets convolution constants, a- angle and coagulation composite index.Results. In women with anemia of ІІІ-rd degree against background of the uterine bleeding, at high activity of primary hemostasis, structural and chronometric hypocoagulation develops; it is predefined by the acute decreasing of fibrinogen in the blood. The principal reason of hypofibrinogenaemia is the excessive activating of non-fermentative fibrinolysis. In conclusion, changes in the system of regulation of the aggregate state of blood in women with severe degree of anemia are the display of subclinical inopexia that develops as a result of thrombocytes high functional activity.

Characteristics of Violations in the Aggregate State of Blood Regulation System of Women with a High Degree Anemia on the Background of Endometrium Hyperplastic Processes

Endometrial hyperplasia is a benign pathology of the uterine mucosa, characterized by certain histological changes, characterized as simple and complex, non-atypical and atypical forms. Hyperplastic processes of endometrium, according to various authors, in the structure of gynecological pathology make up 15 to 40%. Clinically, the endometrial hyperplasia manifest by uterine bleeding. Maternal bleeding that is not susceptible to hormonal, symptomatic, and hemostatic therapy, leads to chronic post-hemorrhagic anemia and is the indication for surgical intervention. Consequently, systemic disorders of the hemostasis parameters on the background of uterine bleeding with endometrial hyperplasia, in particular the regulation of the aggregate state of blood systems, require further research to identify new pathogenetic links and develop correction methods.Materials and methods.State of platelet-vascular hemostasis was assessed by the percentage of platelets adhesion in the blood and by the index of spontaneous platelet aggregation. Total potential coagulation of blood, plasma fibrinolytic activity, plasminogen potential activity, antiplasmin, fibrinogen in blood plasma, the activity of antithrombin III, the concentration of soluble fibrin monomer complexes in the blood was determined by reagents made by Simko Ltd company (Ukraine). Using the «Thromboelastohraph ACG» machine we identified parameters of thrombin clotting rate, thromboelastograph K constant, specific platelets convolution constants, a- angle and coagulation composite index.Results. In women with anemia of ІІІ-rd degree against background of the uterine bleeding, at high activity of primary hemostasis, structural and chronometric hypocoagulation develops; it is predefined by the acute decreasing of fibrinogen in the blood. The principal reason of hypofibrinogenaemia is the excessive activating of non-fermentative fibrinolysis. In conclusion, changes in the system of regulation of the aggregate state of blood in women with severe degree of anemia are the display of subclinical inopexia that develops as a result of thrombocytes high functional activity.

Soluble Fibrin Monomer Complex and Prediction of Cardiovascular Events in Atrial Fibrillation: The Observational Murcia Atrial Fibrillation Project.

Soluble fibrin monomer complex (SFMC) is a biomarker of fibrin formation abnormally elevated in clinical situations of hypercoagulability. We investigated the association and predictive performance of SFMC for stroke, adverse cardiovascular events, cardiovascular mortality and all-cause mortality in a cohort of patients with atrial fibrillation (AF) receiving vitamin K antagonist (VKA) anticoagulant therapy. During the second semester of 2007, we included 1226 AF outpatients stable on VKAs (INR 2.0-3.0) over a period of 6months. SFMC levels were assessed at baseline. During 6.5 (IQR 4.4-8.0) years of follow-up, we recorded all ischemic strokes, adverse cardiovascular events (composite of stroke, acute heart failure, acute coronary syndrome and cardiovascular death), cardiovascular deaths and all-cause deaths. All patients were recruited consecutively. We excluded patients with rheumatic mitral valves, prosthetic heart valves, acute coronary syndrome, stroke, hemodynamic instability, hospital admissions or surgical interventions within the preceding 6months. SFMC levels were measured in plasma by immunoturbidimetry in an automated coagulometer (STALiatestFM, Diagnostica Stago, Asnieres, France). We recorded 121 (1.52%/year) ischemic strokes, 257 (3.23%/year) cardiovascular events, 67 (0.84%/year) cardiovascular deaths and 486 (6.10%/year) all-cause deaths. SFMC >12μg/mL was not associated with stroke but was associated with higher risk of cardiovascular events (HR 1.72, 95% CI 1.31-2.26), cardiovascular mortality (HR 2.16, 95% CI 1.30-3.57) and all-cause mortality (HR 1.26, 95% CI 1.03-1.55). When SFMC >12μg/mL was added to the CHA2DS2-VASc, there were significant improvements in predictive performance, sensitivity and reclassification for adverse cardiovascular events (c-index: 0.645 vs. 0.660, p = 0.010; IDI = 0.013, p < 0.001; NRI = 0.121, p < 0.001) and cardiovascular mortality (c-index: 0.661 vs. 0.691, p = 0.006; IDI = 0.009, p = 0.049; NRI = 0.217, p < 0.001), but decision curves demonstrated a similar net benefit and clinical usefulness. In AF patients taking VKAs, high SFMC levels were associated with the risk of adverse cardiovascular events, cardiovascular mortality and all-cause mortality. The addition of SFMC to the CHA2DS2-VASc score improved its predictive performance for these outcomes, but failed to show an improvement in clinical usefulness.

ВОЛЧАНОЧНЫЙ АНТИКОАГУЛЯНТ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2 ТИПА ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

Цель исследования: изучить распространённость носительства волчаночного антикоагулянта (ВА) среди пациентов, подвергшихся операции коронарного шунтирования (КШ), и оценить влияние ВА на другие показатели гемостаза у этих пациентов. Материалы и методы. Обследовано 40 мужчин в возрасте от 46 до 74 лет, страдающих сахарным диабетом (СД) 2 типа, перенесших операцию КШ. Группу сравнения составили 47 мужчин, перенесших операцию КШ, не имевшие СД. У всех пациентов после операции КШ исследовали содержание в крови ВА, фибриногена, растворимых фибрин-мономерных комплексов (РФМК) и Д-димера. Результаты. Методикой «Экспресс-люпус тест» ВА был обнаружен у 65% пациентов с СД и у 61% пациентов без СД. В группе больных диабетом выявлены прямые связи умеренной силы между количественным показателем «Экспресс-люпус теста» и содержанием в крови фибриногена, РФМК и Д-димера. Заключение. Вероятно, причиной активации системы гемостаза и появления ВА у пациентов с ишемической болезнью сердца является обширное хирургическое вмешательство на сердце и сосудах с применением аппарата искусственного кровообращения. The aim: to study the prevalence of lupus anticoagulant (LA) carriage among patients undergoing coronary bypass surgery (CBG) and to assess LA effect on other hemostatic parameters in these patients. Materials and methods. We examined 40 men (46-74 years old) with diabetes mellitus (DM) type 2 after CBG. The comparison group consisted of 47 men after CBG without DM. In all patients after CBG blood levels of BA, fibrinogen, soluble fibrin-monomer complexes (SFMC) and D-dimer were studied. Results. By «Express-lupus test» method we detected VA in 65% of patients with DM and in 61% of patients without DM. In the group of patients with diabetes direct relationships of moderate strength were revealed between the quantitative parameter of «Express-lupus test» and blood levels of fibrinogen, SFMC and D-dimer. Conclusion. Probably, the cause of hemostasis activation and LA appearance in patients with coronary heart disease is extensive surgical intervention on heart and blood vessels using cardiopulmonary bypass apparatus.

Laboratory signs of activation of the hemostasis system in patients with coronary heart disease, who had coronary artery bypass surgery.

The hypercoagulable state is a risk factor for shunt thrombosis in patients who had coronary artery bypass surgery. That is why the study of factors and operative intervention which can lead to hypercoagulable states are extremely valuable and vital issues. 85 patients who had coronary artery bypass surgery were examined. 40 of them have 2 type diabetes mellitus. All patients underwent a study of the content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, von Willebrand factor, induced platelet aggregation in the blood on the 14th day after the surgery. There were no significant differences in content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, induced platelet aggregation in the blood between patients with diabetes mellitus and patient without diabetes mellitus. It was detected the connection between separate indicators of the hemostatic system studied and age, height, weight, waist circumference and how long ago myocardial infarction had occured. It was detected that indicators of induced platelet aggregation correlate with indicators of lipid metabolism and degree of coronary artery stenosis. According to the information received, progression of hypercoagulable state after coronary artery bypass surgery is depends on weight, waist circumference, age, how long ago myocardial infarction had occurred, indicators of lipid metabolism and degree of atherosclerotic cardiovascular disease of coronary arteries.

Capsule Commentary on Rivera-Caravaca et al., Soluble Fibrin Monomer Complex and Prediction of Cardiovascular Events in Atrial Fibrillation: The Observational Murcia Atrial Fibrillation Project.

Capsule Commentary on Rivera-Caravaca et al., Soluble Fibrin Monomer Complex and Prediction of Cardiovascular Events in Atrial Fibrillation: The Observational Murcia Atrial Fibrillation Project.

Кореляційний аналіз показників гемостазу і функціонального стану печінки за гострого калькульозного холециститу

Introduction.Acute calculous cholecystitis (ACC) is characterized by the development of certain symptoms – from the local inflammatory process to significant functional disorders in the liver. The activity of the hemostasis system is directly related to the functional state of the liver, since hepatocytes are the main site for the synthesis of most proteins, in particular the proteins of the blood coagulation system.The aim of the study – to establish the relationship between the hemostasis system and the functional state of hepatocytes in patients with acute calculous cholecystitis (ACC), uncomplicated and complicated by obstructive jaundice (OJ) using a correlation analysis.Research methods.The subject of the study was plasma and serum of 47 patients with uncomplicated АСС (group I) and 32 patients with АСС with OJ (group II). For comparison, serum and blood plasma of 25 virtually healthy individuals, who were the control group, were examined. The parameters of the hemostasis system platelet count (prothrombin time (PT), activated partial thromboplastin time (APTT), total fibrinogen concentration (TFC), soluble fibrin-monomer complexes (SFMC), antithrombin III (ATIII) and Hageman-dependent fibrinolysis activity were determined (HDF). The determination of indicators of the liver function of the catalytic activity of alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT) and cholinesterase (CHE) and the concentration of α1-antitrypsin (α1-AT),α2-macroglobulin (α2-MG) and C-reactive protein (CRP) was also made.Results and Discussion. The revealed correlations allow determining the degree of conjugacy of processes. The less the number of bonds is the weaker conjugacy of processes, the more flexible becomes the system that responds to the pathological change of the internal environment. The greatest number of correlation bonds was established in the control group of patients. In patients with ACC without complications, there was a tendency to decrease the number of bonds, where α1-AT correlated most withthe investigated parameters. The reduction of the amount and the change of the structure of correlation bonds were found in patients with ACC with OJ. A new correlation between the studied parameters in this group of patients has also been established.Conclusions.The established correlation bonds in uncomplicated ACC and complicated OJ indicate the tension of the adaptive mechanisms of the hemostasis system and the functional state of the liver when the inflammatory process complicates.

The blood coagulation tests from ischemic stroke patients with or without type 2 diabetes mellitus

Objective: We determined the plasma protein C and coagulation factor X activities, prothrombin, fibrinogen and soluble fibrin monomer complex (SFMC) content and performed the haemostatic screening coagulation time tests under acute ischemic stroke patients with or without type 2 diabetes mellitus, as well as evaluated the significance of biochemical haemostatic markers as predictors of mortality in stroke regardless of diabetes presence. Methods: The baseline data were collected from 87 patients during the admission. Neurological disturbances were assessed using the NIH stroke scale. The functional outcome was estimated using Barthel index. All patients underwent fibrinogen and SFMC (gravimetric methods), prothrombin level (ELISA), plasma protein C and coagulation factor X activity assessment, haemostatic screening coagulation time tests with coagulation analyzer, glucose and glycosylated hemoglobin content and BMI (body mass index) measurements. Results: The conducted research had established the changes of fibrinogen and SFMC levels in both investigated patient groups comparing to the control. The protein C activity was found to be significantly decreased in blood of patients with ischemic stroke with and without diabetes. There were differences in factor X activity change in patients with stroke only comparing with patients with diabetes and stroke and high level of this parameter as well as the increase in SFMC can be regarded as death predictors of stroke independently of diabetes mellitus presence. Conclusion: Among ischemic stroke patients with type 2 diabetes mellitus the differences were more significant for all Time tests of the coagulation cascade, but deviations of haemostatic biochemical markers were more pronounced in ischemic stroke patients without diabetes mellitus.

Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

Objective: This study aimed to prospectively evaluate the incidence, characteristics, and risk factors of venous thromboembolism (VTE) development, and the diagnostic value of blood coagulation markers in patients receiving surgery for malignant bone and soft tissue tumor of lower extremity. Methods: A prospective study of 20 patients who were examined using ultrasonography. Serum soluble fibrin monomer complex (SFMC) and D-dimer were measured in the perioperative period. VTE incidence, VTE development time, change in blood coagulation markers, and effect of each risk factor were evaluated. Results: VTE was found in 8 of 20 patients. Four of these 8 patients had the finding of pulmonary embolism (PE) without symptom. Onset time of VTE was from day 1 to 7 after surgery. The cutoff value of SFMC was <3 μg/mL at any measurement point and D-dimer was approximately 2 g/mL in receiver operating characteristic analysis. Body mass index was the only significant risk factor. Conclusion: VTE showed high incidence and often occurred in the early period in only physical prophylaxis after surgery. SFMC or D-dimer was not always useful to detect VTE development. With regard to rehabilitation intervention, risk management is required until 1 week after surgery.

D-dimer predicts pulmonary embolism after low-risk spine surgery.

Introduction Pulmonary embolism (PE) is a risk of mortality following spine surgery. Many studies have demonstrated that deep venous thrombosis (DVT) may affect and actually advance to PE, but few studies have shown how venous thromboembolism (VTE), including PE and DVT, affect blood markers after spine surgery. In this study, we examined changes in blood markers with PE or DVT after low-risk spine surgery, namely cervical laminoplasty or lumbar laminectomy. Methods Seventy-two spine surgery patients were studied. A 16-row multidetector computed tomography was performed before and 3 d after the surgery. Patients with a history of cerebral vascular accident or arterial thrombotic episode or pre-surgical asymptomatic PE or DVT were excluded. Plasma levels of soluble fibrin monomer complex, D-dimer, plasminogen activator inhibitor type-1 (PAI-1), and white blood cell and platelet counts were measured preoperatively and postoperatively at days 1, 3, and 7. Results No patient developed symptomatic post-surgical VTE. Six patients with asymptomatic PE and six with asymptomatic DVT were detected post-surgery, including one patient with both. D-dimer postoperatively at days 3 and 7 was significantly higher in the post-op PE group than in the no-PE group. PAI-1 preoperatively was significantly higher in the DVT and VTE groups than in the no-DVT and no-VTE groups. Conclusions Elevated D-dimer at postoperative days 3 and 7 is a predictive factor for the early diagnosis of PE after spine surgery. Moreover, elevated PAI-1 preoperatively is a predictive factor for the early diagnosis of DVT and VTE. Consequently, PE may occur through a pathway other than DVT.

Fibrinogen and prothrombin blood content under ischemic stroke complicated by type 2 diabetes mellitus

The article is dedicated to evaluation of general clinical and some hemostatic parameters (fibrinogen, soluble fibrin monomeric complexes and prothrombin content) of patients with ischemic stroke under presence or absence of type2 diabetes mellitus. It has been established that diabetes mellitus patients with ischemic stroke are more likely to have hyperlipidemia, peripheral vascular disease and high body mass index. The conducted research has established the statistically significant changes of fibrinogen and soluble fibrin monomer complexes (SFMC) levels under both investigated pathologies (ischemic stroke and ischemic stroke complicated by insulin-independent diabetes mellitus). SFMC, the early marker of thrombophilia, was significantly higher compared to the reference values in case of stroke as well as stroke with diabetes. It was established that fibrinogen indexes were higher under IS with DM, whereas SFMC had more deviated meanings comparing with the control parameters under ischemic stroke alone. The higher SFMC level in acute phase of stroke independently of diabetes present was a statistically confirmed predictor of mortality.Nevertheless statistically significant differences of fibrinogen and SFMC levels in patients with ischemic stroke and IS+DMwere not detected and there were no differences of protrombin content neither comparing with the control nor between the studied pathologies. The obtained results have shown that ischemic stroke with and without type 2 diabetes mellitus are characterized by similar changes of the investigated hemostasis parameters

Hypercoagulability in patients with atrial fibrillation and associated obesity: a way to hemorrhage or thromboembolia?

Despite the increased hypercoagulability of the blood plasma in patients with AF, the study of the processes of plasma hemostasis has still received insufficient attention, especially in patients with comorbid obesity or with excessive body weight. Purpose of the study. To establish the specific features of the effect of concomitant obesity on the indices of plasma hemostasis in patients with AF, on the basis of which to identify prognostically significant risk factors for adverse arrhythmia. Materials and methods. 75 patients with permanent AF were examined. For deducing prognostically significant risk factors, we conducted a retrospective analysis of the case histories of 421 inpatients. Results. The presence of concomitant obesity in patients with AF is accompanied by an acceleration of the prothrombinase-forming stage both in the internal and external hemocoagulation pathways. At the same time, the increase in procoagulant properties of blood is associated with a significant increase in fibrinogen and soluble fibrin-monomer complexes against the background of depletion of fibrinolytic and anticoagulant blood activity, which is a reflection of changes at the level of all links of hemocoagulation. Most diagnostically significant coagulation factors in the risk of thrombotic complications in patients with atrial fibrillation and concomitant obesity can be considered a measure of INR 30 minutes. Prognostically significant risk factors for small bleeding in patients with AF and associated obesity when taking warfarin are a BMI> 40kg/m 2 , level of AT III ≥40 % and ≥130 %, and in patients with AF and normal body weight, the amount of small bleeding increases if variability of INR beyond 2.0–3.0 and levels of AT III ≥130 %, as well as in the spring period of the year. Conclusions. Patients with AF are characterized by a moderate increase in the thrombogenic potential of the blood, which is accompanied by a significant inhibition of anticoagulant activity, while an increase in BMI leads to further deterioration of hemostasis equilibrium with an increase in procoagulant properties, depletion of fibrinolytic and anticoagulant blood activity.

Disorders of the hemostatic system as a possible predictor of emergency in divers

The article presents experimental data on the effect of hyperoxia, antiorthostasis and their combined effect on the hemostatic system in Wistar rats. It was found that the both hyperoxia and antiorthostasis caused acceleration of the final stage of blood clotting, increasing the concentration of fibrinogen and the appearance of soluble fibrin monomer complexes. The potential danger of thrombosis caused by hyperoxia or antiorthostasis is worsen by reducing fibrinolytic activity of blood plasma. No changes in the platelet hemostasis were observed. Combined action of hyperoxia and antiorthostasis caused signs of activation of both the coagulation and platelet hemostasis. Platelet aggregation increased by 1,2 times compared to the control, indicating aggravating impact of the combined action of hyperoxia and antiorthostasis on platelet hemostasis and the prothrombin time, and caused changes in the direction of anticoagulation. The combined action caused also more pronounced reduction of fibrinolytic activity of blood and enhanced level of soluble fibrin monomer complexes, which were one of the earliest markers of hidden thrombinemia. We believe that in people with a balance in the hemostasis system shifted toward increased thrombophilia, etc., with the combined action of hyperoxia and antiorthostasis, the compensatory capabilities of the hemostatic system will be depleted and lead to the development of pathological conditions. Taking this into account, we recommend to divers the in-depth control of the hemostasis system in order to prevent her disorders.

The analysis of blood coagulation changes in patients with hypertension in combination with chronic obstructive pulmonary disease varying degrees of severity

Aim of research was to determine the influence of COPD severity on the plasma hemostasis condition in patients with HT combined with COPD. Materials and methods. 79 patients were examined: 15 almost healthy (control) and 64 patients with stage II HT with concomitant COPD. Depending on the COPD severity, the patients were divided into 3 groups: group A- 11 patients with HT and COPD of the I severity degree; Group B - 28 patients with HT and COPD of the II severity degree; Group B - 25 patients HT and COPD of the III severity degree. Special laboratory tests: coagulation indicators - activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, soluble fibrin monomer complexes, ancistron test, Lebetox test, and echitox test were carried out. Results: in result of the study it was found that comorbid HT and COPD course is characterized by increased activity of hemostasis system coagulation level, which intensity is associated with bronchial obstruction severity. In particular, COPD of the III severity degree hyperfibrinogenemia, as well as soluble fibrin monomer complexes significant increase were observed in all subgroups of the patients with HT and COPD, accompanied by activation of external pathway of coagulation and combined with accelerated processes of prothrombinase-, trombino- and fibrin formation according to specific snake venoms tests. Conclusion. Comorbid HT and COPD course is characterized by the activation of hemostasis system coagulation level, which intensity is associated with bronchial obstruction severity. Hyperfibrinogenemia and a significant increase of the SFMC content, observed in all subgroups of the patients with HT and COPD, at COPD of the III severity degree are accompanied by activation of external pathway of coagulation and combined with accelerated processes of prothrombinase-, trombino- and fibrin formation according to specific snake venoms tests. The patients with HT combined with COPD of the III severity degree need careful laboratory monitoring to solve the problem of the additional antithrombotic correction necessity

Особливості змін показників системи гемостазу та рівня с-реактивного протеїну у хворих на гострий холецистит

Introduction. Acute cholecystitis, which is requently complicated by the bile ducts mechanical obstruction, is characterized by a variety of symptoms – from local inflammation to significant changes in hepatocytes and cholestatic intoxication. These symptoms often manifest violation of the liver functions, which is involved in the synthesis of most proteins, as the system of hemostasis, as well as the so-called «acute phase proteins».The aim of the study – to determine and conduct comparative analysis of hemostatic parameters and level of C-reactive protein (CRP) in patients with acute calculous cholecystitis (ACC).Methods of the research. 67 people were examined: 20 of them – healthy, 25 – patients with ACC without complications (1 group) and 22 – patients with ACC complicated with obstructive jaundice (2 group ). The study of hemostasis was performed by determining platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen concentration, the content of soluble fibrin-monomeric complexes (SFMC), antithrombin III activity (ATIII) and Hagemann-dependent fibrinolysis. Determination of CRP level in blood serum was also performed.Results and Discussion. We found a significant elongation of the PT, APTT, increased concentration of fibrinogen, SFMC content, Hagemann-dependent fibrinolysis and the level of CRP in patients with ACC in comparison with the control group (p&lt;0.05, p&lt;0.001). In addition, a significant decrease in ATIII level and reduction of the number of platelets in patients with ACC in comparison with the practically healthy people (p&lt;0.05) was found.Conclusions. The basis of the identified changes in parameters of hemostasis system most likely lies in hepatocellular insufficiency as the cause of the reduced synthesis of many components of haemostasis on the background of inflammatory liver damage. Disorders of primary and secondary hemostasis with insufficient anticoagulants activity can lead to multiple lesions in hemodynamics and microcirculation. The increase in the content of SFMC in plasma suggests the presence of DIC syndrome. A prolongation of PT and APTT will characterize DIC syndrome as the use factors of a phase hypocoagulation.A significant increase in the level of CRP in patients with ACC complicated with obstructive jaundice indicates its involvement in the progress of the inflammatory process.

Difference in the changings of blood coagulation fibrinolysis markers before and after spinal surgery in adolescent and elderly patients

AIM: The purpose of this study is to investigate the differences in changing of blood coagulation and fibrinolysis markers before and after spinal surgery in adolescent and elderly patients. MATERIALS AND METHODS: This retrospective two-center study enrolled 56 low-risk patients between October 2012 and April 2015. 27 adolescent idiopathic scoliosis (AIS) patients (3 boys, 24 girls; mean age 15 years) underwent instrumentation for posterior fusion. 29 lumbar spinal canal stenosis (LSCS) patients (15 men, 14 women; mean age 71 years) underwent laminectomy for posterior decompression. Plasma levels of soluble fibrin monomer complex (SFMC), D-dimer, and plasminogen activator inhibitor type 1 (PAI-1) were measured at 1 day preoperatively and on postoperative days (PODs) 1, 3, and 7. RESULTS: The SFMC level showed significant increases on PODs 1 and 3 in the AIS patients and on POD 1 in the LSCS patients. The D-dimer level showed significant increases on PODs 1, 3, and 7 in both groups. The PAI-1 levels showed significant increases on POD 7 in the AIS patients and on PODs 1, 3, and 7 in the LSCS patients. CONCLUSION: The significantly continuously higher postoperative PAI-1 levels in older patients could be associated with the development and progression of symptomatic VTE.

大腸癌周術期発症の肺血栓塞栓症診断に可溶性フィブリンモノマー複合体（SFMC）測定が有用であった1例

大腸癌周術期発症の肺血栓塞栓症診断に可溶性フィブリンモノマー複合体（SFMC）測定が有用であった1例