Comparative evaluation of preventive anticoagulant therapy regimens in the wounded
https://doi.org/10.21518/ms2023-196
Abstract
Introduction. Currently, the issues of prescribing anticoagulant therapy to the wounded are poorly studied, the doses of drugs and the timing of its implementation have not been determined.
Aim. To study various modes of anticoagulant therapy for the prevention of venous thrombosis of the lower extremities in the wounded after surgery using the parameters of the plasma hemostasis system and the Thrombodynamics test.
Materials and methods. A prospective study was conducted, which included 90 wounded with mine-explosive/gunshot injury receiving anticoagulant therapy in preventive doses. The studies were carried out on the equipment of the Thrombodynamics recorder (HemaCor, Moscow). The patients were divided into 3 groups: 1 group, which included 30 patients taking rivaroxaban at a dose of 10 mg/day, 2 group of 30 patients receiving enoxaparin sodium at a dose of 40 mg once a day, 3 group consisting of 30 patients receiving enoxaparin sodium 40 mg 2 times a day. In the dynamics of treatment, the parameters of the plasma hemostasis system and the parameters of the Thrombodynamics test were evaluated.
Results. It was revealed that during preventive anticoagulant therapy, there were no significant differences in the standard parameters of the coagulogram, when studying the parameters of the Thrombodynamics test, significant differences were
observed between groups 1 and 3 in values (V/VSt, Vi, Tlag, СS), between group 2 and 3 in parameter (V/VSt, Vi, Tlag, СS), between group 1 and group 2 in the value of D. A statistically significant relationship was found between the Thrombodynamics parameter D and the indicators of TV, prothrombin by Quick, and fibrinogen content.
Conclusion. The Thrombodynamics test can be used as a potential tool for a personalized approach to monitoring the hemostasis system in the wounded.
About the Authors
N. A. VaravinRussian Federation
Nikita A. Varavin - Cardiologist of the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov.
6, Akademik Lebedev St., St Petersburg, 194044
V. V. Salukhov
Russian Federation
Vladimir V. Salukhov - Dr. Sci. (Med.), Associate Professor, Head of the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov.
6, Akademik Lebedev St., St Petersburg, 194044
E. V. Kryukov
Russian Federation
Evgeny V. Kryukov - Acad. RAS, Dr. Sci. (Med.), Professor, Head.
6, Akademik Lebedev St., St Petersburg, 194044
V. A. Kolodyazhnaya
Russian Federation
Victoria A. Kolodyazhnaya - Head of the Express Diagnostics Laboratory, Doctor of Clinical Laboratory Diagnostics, Center for Clinical Laboratory Diagnostics.
6, Akademik Lebedev St., St Petersburg, 194044
References
1. Petrov A.N., Borisov M.B., Denisenko V.V., Ganin E.V., Semenov E.A., Koskin V.S., Samokhvalov I.M. Prevention of acute thromboembolic events in patients with multistage surgical treatment was combined skeletal trauma. Emergency Medical Care. 2016;17(2):42–48. (In Russ.) Available at: https://smp.spb.ru/jour/article/view/139.
2. Trishkin D.V., Kryukov E.V., Chuprina A.P., Kotiv B.N., Samokhvalov I.M., Esipov A.V. et al. Methodical recommendations for the treatment of combat surgical trauma. Moscow; 2022. 373 p. (In Russ.) Available at: https://medicine.mil.ru/upload/site299/document_file/XWyL6jsziB.pdf.
3. Khubulava G.G., Gavrilov E.K., Bolotokov H.L., Sadovoy S.V. Venous thromboembolic complications. Grekov’s Bulletin of Surgery. 2019;178(1):77–81. (In Russ.) https://doi.org/10.24884/0042-4625-2019-178-1-77-81.
4. Ruskin K.J. Deep vein thrombosis and venous thromboembolism in trauma. Curr Opin Anaesthesiol. 2018;31(2):215–218. https://doi.org/.1097/ACO.0000000000000567.
5. Nikolaev K.N., Zubritsky V.F., Koltovich A.P., Vardanyan A.V., Kapustin S.I., Dolidze D.D., Vardanyan V.A. Prevention of venous thromboembolic complications in firearm injury. Pirogov Russian Journal of Surgery. 2018;(9):82–86. (In Russ.) https://doi.org/10.17116/hirurgia2018090182.
6. Nikolaev K.N., Zubritsky V.F., Kapustin S.I., Koltovich A.P., Zakharov R.S. Pulmonary embolism in a wounded with mine blast injury against the background of anticoagulant prophylaxis (case report). Traumatology and Orthopedics of Russia. 2015;21(3):86–91. (In Russ.) Available at: https://journal.rniito.org/jour/article/view/149.
7. Nikolaev K.N., Zubritsky V.F., Koltovich A.P., Ivchenko D.R., Akimov A.V., Golubov E.A. et al. A Differentiated approach to vein thromboembolic complication prevention in military low-extremity firearm injury. Vestnik Sovremennoi Klinicheskoi Mediciny. 2018;11(1):38–44. (In Russ.) https://doi.org/10.20969/VSKM.2018.11(1).38-44.
8. Bokeria L.A., Zatevakhin I.I., Kirienko A.I., Andriyashkin A.V., Andriyashkin V.V., Arutyunov G.P. et al. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Flebologiya. 2015;9(4-2):1–51. (In Russ.) Available at: https://webmed.irkutsk.ru/doc/pdf/pe2015.pdf.
9. Mironov S.P., Kirienko A.I., Skoroglyadov A.V., Andriyashkin V.V., Arzhakova N.I., Akhtyamov I.F. et al. Prophylaxis of venous thromboembolic complications in traumatology and orthopedics: Russian clinical guidelines. Traumatology and Orthopedics of Russia. 2012;18(Suppl. 1):1–24. (In Russ.) Available at: https://webmed.irkutsk.ru/doc/pdf/peortoped.pdf.
10. Zelenina N.V., Nazarov S.S., Marchenko A.A., Yusupov V.V. Features of adaptation in combatants and estimation their stress resilience. Russian Military Medical Academy Reports. 2019;38(3):59–65. (In Russ.) Available at: https://journals.eco-vector.com/RMMArep/article/view/26068.
11. Von Känel R. Acute mental stress and hemostasis: when physiology becomes vascular harm. Thromb Res. 2015;135(Suppl. 1):S52–S55. https://doi.org/10.1016/S0049-3848(15)50444-1.
12. Lipets E.N., Ataullakhanov F.I., Panteleev M.A. Integrated laboratory coagulation tests in hypercoagulation diagnosis and thrombosis risk assessment. Part II. The sensitivity of integral tests to hypercoagulable states. Oncohematology. 2015;10(3):78–91. (In Russ.) https://doi.org/10.17650/1818-8346-2015-10-3-78-91.
13. Dementeva G.I., Lobastov K.V., Skopintsev V.B., Laberko L.A. The possibility of global assessment tests of the hemostatic system in the prediction of venous thromboembolism in surgical practice. Surgeon. 2017;(4):27–38. (In Russ.) Available at: https://panor.ru/articles/vozmozhnosti-globalnykhtestov-otsenki-sistemy-gemostaza-v-prognozirovanii-venoznykhtromboembolicheskikh-oslozhneniy-v-khirurgicheskoy-praktike/56973.html.
14. Mikheeva A.V., Afonchikov V.S., Volchkov V.A. Changes in indices of thromboelastogram in patients with severe sepsis and septic shock. Medical Alphabet. 2018;3(26):26–30. (In Russ.) Available at: https://www.med-alphabet.com/jour/article/view/827.
15. Ataullakhanov F.I., Rumyantsev A.G. New insights into the blood clotting. Russian Journal of Pediatric Hematology and Oncology. 2018;5(3):13–22. (In Russ.) https://doi.org/10.17650/2311-1267-2018-5-3-13-22.
16. Podoplelova N.A., Sulimov V.B., Ilin I.S., Tashilova A.S., Panteleev M.A., Ledeneva I.V., Shikhaliev K.S. Blood coagulation in the 21st century: existing knowledge, current strategies for treatment and perspective. Pediatric Hematology/Oncology and Immunopathology. 2020;19(1):139–157. (In Russ.) https://doi.org/10.24287/1726-1708-2020-19-1-139-157.
17. Schastlivtsev I.V., Lobastov K.V., Tsaplin S.N., Mkrtychev D.S. Modern view on hemostasis system: cell theory. Meditsinskiy Sovet. 2019;(16):72–77. (In Russ.) https://doi.org/10.21518/2079-701X-2019-16-72-77.
18. Shulutko E.M. (ed.). Application of the thrombodynamics test to assess the state of the hemostasis system: educational and methodological recommendations. Moscow; 2015. 72 p. (In Russ.)
19. Sychev D.A., Sinitsina I.I., Tsomaya I.V., Vardanyan A.V., Levanov A.N. Clinico-pharmacological and clinical basis of multiplicity of intake of novel oral anticoagulants. Kardiologiia. 2017;57(11):84–93. (In Russ.) Available at: https://lib.ossn.ru/jour/article/view/63.
20. Gebekova Z.A., Ivanov I.I., Asambayeva A., Skripka A.I., Sokolova A.A., Napalkov D.A., Vuimo T.A. Thrombodynamics Test in Assessing the Risk of Thrombus Formation in Patients with Atrial Fibrillation Taking Direct Oral Anticoagulants. Rational Pharmacotherapy in Cardiology. 2022;18(5):544–552. https://doi.org/10.20996/1819-6446-2022-09-07.
21. Gracheva M.A., Urnova E.S., Sinauridze E.I., Tarandovskiy I.D., Orel E.B., Poletaev A.V. et al. Thromboelastography, thrombin generation test and thrombodynamics reveal hypercoagulability in patients with multiple myeloma. Leuk Lymphoma. 2015;56(12):3418–3425. https://doi.org/10.3109/10428194.2015.1041385.
22. Balandina A.N., Serebriyskiy I.I., Poletaev A.V., Polokhov D.M., Gracheva M.A., Koltsova E.M. et al. Thrombodynamics – A new global hemostasis assay for heparin monitoring in patients under the anticoagulant treatment. PLoS ONE. 2018;13(6):e0199900. https://doi.org/10.1371/journal.pone.0199900.
23. Chugunov A.A., Salukhov V.V., Dantseva O.V., Kharitonov M.A., Rudakov Yu.V., Bolekhan A.V., Arzhavkina L.G. Some aspects of application glucocorticoid drugs in the complex treatment of new coronaviral infection. Medical Alliance. 2021;9(1):43–51. (In Russ.) https://doi.org/10.36422/23076348-2021-9-1-43-51.
24. Lobastov K., Dementieva G., Soshitova N., Bargandzhiya A., Barinov V., Laberko L., Rodoman G. Utilization of the Caprini score in conjunction with thrombodynamic testing reduces the number of unpredicted postoperative venous thromboembolism events in patients with colorectal cancer. J Vasc Surg Venous Lymphat Disord. 2020;8(1):31–41. https://doi.org/10.1016/j.jvsv.2019.06.015.
25. Salukhov V.V., Gulyaev N.I., Dorokhina E.V. Assessment of systemic inflammatory reactions and coagulopathy against the background of hormonal therapy in COVID-associated lung damage. Meditsinskiy Sovet. 2020;(21):230–237. (In Russ.) https://doi.org/10.21518/2079701X-2020-21-230-237.
26. Avdeev S.N., Bazarova A.V., Baranova E.I., Esayan A.M., Zhusupova G.K., Zamyatin M.N. et al. Resolution of the International meeting of experts on the exchange of scientific experience in the use of anticoagulants in patients with COVID-19. Russian Journal of Cardiology. 2020;25(9):92–94. (In Russ.) https://doi.org/10.15829/1560-4071-2020-4099.
27. Bovt E.A., Brazhnik V.A., Bulanov A.Yu., Vasilyeva E.Yu., Vuimo T.А., Zateyshchikov E.N. et al. Results of multicenter monitoring of hemostasis parameters in patients with COVID-19. Pediatriya – Zhurnal im G.N. Speranskogo. 2020;99(6):62–73. (In Russ.) https://doi.org/10.24110/0031-403X-2020-99-6-62-73.
28. Vuimo T.S., Tsarenko S.V., Filimonova E.V., Seregina E.A., Karamzin S.S. Correction of Anticoagulant Therapy in Patients with Severe COVID-19 Virus Infection Using a Thrombodynamics Coagulation Assay. Clin Appl Thromb Hemost. 2022;28:10760296221142862. https://doi.org/10.1177/10760296221142862.
29. Krylov A.I., Shulutko A.M., Prasolov N.V., Petrovskaya A.A., Khmyrova S.E. Coagulological aspects of treatment of complications of prolonged therapy with warfarin. Angiology and Vascular Surgery. 2016;22(3):33–41. (In Russ) Available at: https://www.angiolsurgery.org/magazine/2016/3/4.htm.
30. Krechetova L.V., Nechipurenko D.Yu., Shpilyuk M.A., Beznoshchenko O.S., Beresneva E.A., Markelov M.I. et al. The use of the thrombodynamics test in the diagnostics of hemostasis disorders in patients with COVID-19 of varying severity. Journal of Clinical Practice. 2021;12(4):23–37. (In Russ) https://doi.org/10.17816/clinpract88138.
Review
For citations:
Varavin NA, Salukhov VV, Kryukov EV, Kolodyazhnaya VA. Comparative evaluation of preventive anticoagulant therapy regimens in the wounded. Meditsinskiy sovet = Medical Council. 2023;(13):305-311. (In Russ.) https://doi.org/10.21518/ms2023-196