USING THE THROMBODYNAMICS TEST IN THE INTEGRATED PERIOPERATIVE MONITORING OF THE BLOOD COAGULATION SYSTEM IN SURGICAL PATIENTS

Aim. The research was conducted to evaluate the possibilities of the "Thrombodynamics" test in the integrated monitoring of the blood coagulation system and the choice of the method of prophylaxis of thromboembolic complications in the postoperative period in surgical patients.

Materials and methods. 123 patients were operated for acute surgical pathology of abdominal organs. The "Thrombodynamics" test was used in a complex assessment of the state of the blood coagulation system. After the statistical processing by the methods of variation statistics, the results were used to predict the risk of the occurrence and changes in the volume of therapy for thromboembolic complications, taking into account the current understanding of the thrombodynamic properties of the fibrinous clot. Correction of the hemostasis system was based on "Russian Clinical Recommendations for the Diagnosis, Treatment and Prevention of Venous Thromboembolic Complications" approved by the Expert Meeting on May 20, 2015.

Results. It was found that 101 (82.1%) patients had abnormalities in the blood coagulation system after the surgery for acute abdominal cavity diseases complicated by peritonitis. We established the direct dependence of the predicted risk of thromboembolic complications on the degree of severity of secondary peritonitis. 52 (42.3%) patients needed a correction of thromboprophylactic therapy, which made it possible to exclude the occurrence of venous thromboembolic complications.

Conclusion. The use of the "Thrombodynamics" test in the complex evaluation of the qualitative characteristics of the blood coagulation system in surgical patients with a complicated course of the disease in the perioperative period makes it possible to objectively assess the risks of the thromboembolic complications and to correct a thromboprophylactic therapy to exclude the thromboembolic complications. 

1. Rossijskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhnenij. Flebologiya. 2015; 4(2): 52. (In Russ.).

2. Hyers TM, Hull RD, Weg JG. Antithrombotic therapy for venous thromboembolic disease. Chest. 1995; 108(4): 335-351.

3. Duranteau J., Taccone F.S., Verhamme P., Ageno W. European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care. Eur J Anaesthesiol. 2018; 35(2): 142-146.

4. Kirienko A.I., Leont'ev S.G., Lebedev I.S., Seliverstov E.I. Profilaktika venoznyh tromboembolicheskih oslozhnenij v hirurgicheskoj praktike. Consilium medicum. 2012; 8: 7. (In Russ.).

5. Vujmo T.A. Laboratornyj kontrol antikoagulyantnoj terapii metodom trombodinamiki. Materialy obshcherossijskoj nauchno-prakticheskoj konferencii «Effektivnaya laboratornaya medicina: metody i sredstva analiza, sposoby organizacii i standarty praktiki». Moskva. 2013: 76. (In Russ.).

6. Serebrijskij I.I. Novye laboratornye metody dlya ocenki sistemy gemostaza. Materialy obshcherossijskoj nauchno-prakticheskoj konferencii «Effektivnaya laboratornaya medicina: metody i sredstva analiza, sposoby organizacii i standarty praktiki». Moskva. 2013: 83-84. (In Russ.).

7. Jacobs B., Henke P.K. Evidence-Based Therapies for Pharmacologic Prevention and Treatment of Acute Deep Vein Thrombosis and Pulmonary Embolism. Surg Clin North Am. 2018; 98(2): 239-253.

8. Balandina A.N. Registraciya fibrinoliza metodоm trombodinamiki. Materialy obshcherossijskoj nauchno-prakticheskoj konferencii «Effektivnaya laboratornaya medicina: metody i sredstva analiza, sposoby organizacii i standarty praktiki». Moskva. 2013: 22. (In Russ.).

9. Wells P.S. Excluding P.E. at the bedside with diagnostic imaging: management of patients with suspected embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001; 135(2): 98-107.

10. Caprini J.A. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. The American Journal of Surgery. 2010; 199(1): 3-10.