ACTIVATION OF INTRAVASCULAR MICROCOAGULATION OF BLOOD IN PATIENTS WITH ATHEROSCLEROTIC GANGRENE OF THE LOWER LIMBS

Kuzmin V.V., Tsaregorodtseva N.A., Yurchenko L.N.
Chair of Anaesthesiology and Critical Care Medicine with the Course of Transfusiology of the Faculty of Advanced Medical Training and Postgraduate Education Institute of Immunology and Physiology of the Uralian Branch of the Russian Academy of Sciences,
Ekaterinburg, Russia

A prospective study was carried out in order to investigate the system of haemostasis in a total of sixty patients presenting with atherosclerotic gangrene of a lower extremity who were then subjected to high amputation. The operative intervention was preceded and followed by determining the following parameters: antithrombin III (АТШ), fibrinogen (FG), thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), the number of the soluble fibrinmonomeric complexes (SFMC) and Ddimers, euglobulin fraction clot lysis time, the amount and aggregation activity of blood platelets. The findings obtained while studying haemostasis in patients with irreversible ischaemia of the lower limbs demonstrated activation of the intravascular microcoagulation of blood prior to the operation. The immediate postoperative period was marked by preservation of the shortened APTT, high concentration of fibrinogen, elevated euglobulin clot lysis time, high concentrations of SFMCs and Ddimers of blood, which created conditions for the development of thrombotic complications even in a relatively stable course of the postoperative period. The authors underline the necessity of determining an optimal mode of prescribing and administering appropriate doses of direct anticoagulants in the early and immediate postoperative period, as well as that of making an appropriate decision of whether or not to use indirect anticoagulants for correction of haemostasis in these patients during the remote postoperative period.

KEY WORDS: atherosclerotic gangrene of the lower limb, high amputation of the lower extremity, activation of intravascular microcoagulation of blood.

P. 30

« Back