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Modelling prognostic values of parameters of thrombin generation test conducted on patients with coronary complications during first year after percutaneous intervention

Abstract

Introduction. Percutaneous coronary intervention (PCI) with stent-ing of the coronary arteries is a common method of treatment of stable coronary artery disease (CAD), however, in the postoperative period, there may be complications of thrombotic and stenotic nature. The thrombin generation test (TGT) is an integral method for assessing the pre-thrombotic state of the hemostatic system, but there are no data on its predictive value in this group of patients. Aim. To select the most informative parameters of TGT for constructing prognostic models of distant thrombotic complications in patients with CAD after stenting of the coronary arteries. Objective. 75 patients (15 women and 60 men) aged 40-75 years who had indications for PCI and 23 patients who did not have clinical manifestations of coronary artery disease were included in the study. TGT was performed in platelet-poor plasma in standard modification and with the addition of thrombomodulin (TM). In both variants, the delay time (Lag time, min), endogenous thrombin potential (ETP, nmol/min.), peak thrombin height (Peak, nmol), peak time (ttPeak, min) were estimated. Based on the results of observation of the course of the postoperative period within 12 months, two groups of patients were isolated: group 1 - without complications and repeated operations (60 people) and group 2 - patients with complications in the form of acute coronary syndrome or scheduled revascularization (15 persons). Results. On day 3rd after revascularization, the level of ETP with the addition of TM in patients with thrombotic complications is higher than in patients with a favorable postoperative period (95 %-probability of finding ET in the range 1328.80-1869.63 and 1013.19-1228.59 nmol/min., respectively). Later, by the 90th day after PCI, they retained increased thrombin generation (1781.23-1831.28 nmol/min.), and with a favorable variant, a decrease in ETP was observed practically to the level of patients in the control group (1566.55-1605.62 and 1643,5-168.6 nmol/min., respectively). Conclusions. The most informative in the dynamic observation of the indicator of TGT is ETP. To model the direction of changes in the parameter ETP with and without addition of TM in patients of the two groups, one-factor regression changes can be used as follows: Y = bo * t01 (J) - for patients of group 1 at 3rd and 90fh days after PCI; Y = J/(b1 - b2/t) (2) and Y = bo + b1/t (3) - for patients of group 2 on days 3rd and 90th after the operation, respectively (Y - values of parameter ETP, nmol/min.; t - time elapsed after the PCI, days; b0-2 - coefficients). It is expedient to determine the ETP in the early postoperative period (on day 3rd) in the modification of TGT with TM and in the late (90th - 365fhdays) without the addition of TM.

About the Authors

V. A. Yudina
North-West Federal Medical Research Centre n.a. V. A. Almazov
Russian Federation


O. S. Melnichnikova
North-West Federal Medical Research Centre n.a. V. A. Almazov
Russian Federation


M. A. Karpenko
North-West Federal Medical Research Centre n.a. V. A. Almazov
Russian Federation


T. V. Vavilova
North-West Federal Medical Research Centre n.a. V. A. Almazov
Russian Federation


E. V. Vorobeychikov
Polypharm Co
Russian Federation


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Review

For citations:


Yudina V.A., Melnichnikova O.S., Karpenko M.A., Vavilova T.V., Vorobeychikov E.V. Modelling prognostic values of parameters of thrombin generation test conducted on patients with coronary complications during first year after percutaneous intervention. Medical alphabet. 2018;1(4):22-27. (In Russ.)

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ISSN 2078-5631 (Print)
ISSN 2949-2807 (Online)