COMPLEX CORRECTION OF DISORDERS OF THE HEMOSTASIS SYSTEM IN PATIENTS WITH UTERINE BODY CANCER AFTER SURGICAL INTERVENTION
About the author:
Tarabrin O. A., Bosenko K. V., Dusenko A. A.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
We carried out a comprehensive dynamic study of the state of the hemostasis system in 87 gynecological patients. What was the diagnosis - the cancer of the body of the uterus, which were divided into 2 groups. To group 1 – 44 women were included in the following thrombotic prophylaxis: bemiparin 2500 IU and pentoxifylline. Up to 2 groups included 43 individuals with the scheme of thromboprophylaxis - bemiparin 2500 IU. All patients undergo extravasation of the uterus with appendages. The control group included 30 practically healthy women of reproductive age. All patients undergo extirpation of the uterus with appendages. To prevent thromboembolic complications in the preoperative and postoperative periods, all patients used measures of non-specific prophylaxis (elastic bandage of the lower extremities, therapeutic exercises, early activation of patients, massage, etc.). Results. All these changes in the system of hemostasis occurring in patients with cancer of the poppies indicate that the system of regulation of the aggregative state of the blood is in a very difficult condition and requires careful attention to every link of hemostasis. Using piezotromboelastography in women of group 1, a comparative study of the values of the parameters of the coagulation linkage of hemostasis received in the preoperative period at 1, 3 and 6 days of treatment was performed. The obtained results indicate the probable changes and the effectiveness of the applied methods of correction of disorders of the coagulation link of hemostasis. Due to the applied correction scheme for patients in group 1 up to 6 days of treatment, a moderate tendency towards normo aggregation and normocoagulation and a significant reduction of violations in the coagulation unit of the system of regulating the aggregate state of blood was established. Compared with the values obtained in the 1 day of treatment up to 6 days, the positive tendency towards normalization of the indicators approaching the values obtained from control group women and healthy volunteers is maintained. In subjects of the 2nd group, the activation of the vascular-thrombocyte linkage of hemostasis in the direction of hyperaggregation was observed, which remained almost unchanged throughout the study period. In the coagulation link of the hemostasis system, reduction of manifestations of chronometric and structural hypercoagulation was noted. Due to the correction, the positive dynamics of the indicators of KTA, PSC, IR, MA, in the direction of normocoagulation, as well as normalization of the fibrinolytic linkage of hemostasis in comparison with the norm, was obtained. In patients with 2 groups, after surgery, the dynamics of the system of hemostasis was less positive. The condition of the hemostasis system was characterized by a high potential of aggregative activity, and moderate positive changes in the coagulation potential. Changes in patients with cancer of the uterus indicate a very tense state of the system of regulating the aggregate state of blood, which requires careful attention to each link of hemostasis. Intensive pathogenetic therapy (including hemodilution, rheology and anticoagulation therapy) and a comprehensive approach to correction of hemostasis system leads to a possible positive effect on the coagulation link. In the course of complex thromboprophylaxis with the use of antiplatelet and anticoagulants of direct action, development of a possible positive dynamics from the platelet aggregation, normalization of the parameters characterizing various stages of coagulation and fibrinolytic links of the hemostasis system was noted. In analyzing the history of the diseases of the operated patients, which were distributed by us to the groups depending on the integrated approach to thromboprophylaxis, it was found that among women of group 1 the probable lower frequency of thromboembolic complications than patients in group 2 (9.3% versus 25.2% (p <0.05)). Conclusions. The obtained results testify to the high efficiency of the proposed complex thromboprophylaxis method in patients with uterine cancer, which was proved by continuous monitoring of the parameters of the RASC system using low-frequency piezoelectric hemovioscosimetry, which can be considered a modern objective method for monitoring the hemostasis system.
uterine cancer, thromboprophylaxis, bemiparin, pentoxifylline, surgery, piezo thromboelastogram
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 206-211 pages, index UDK 618.14-006.6-089-06:616.151.5]-085