Criteria for efficacy of anticoagulant therapy in patients with thromboses of deep veins of lower limbs

Krylov A.Yu.¹, Shulutko A.M.¹, Serebriisky I.I.², Verkholomova F.Yu.^2,3, Khmyrova S.E.¹, Petrovskaya A.A.¹

1) First Moscow State Medical University named after I.M. Sechenov,
2) Limited Liability Company "Haematological Corporation",
3) Federal Research Clinical Centre of Paediatric Haematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia

The authors analysed the results of a prospective study of dynamics of laboratory indices of plasma haemostasis on the background of anticoagulant therapy in a total of 60 patients (23 women and 37 men) presenting with idiopathic thromboses of deep veins of lower limbs in order to work out criteria for its efficacy and safety. Anticoagulant therapy was carried out using nonfractionated heparin according to the standard regimens. The patients’ mean age amounted to 57.4±13.6 years. Studying the system of haemostasis along with generally known standard laboratory indices (activated partial prothrombin time, D-dimer, fibrinogen, prothrombin level, INR, PTI) included one of the global coagulogical tests – a method of thrombodynamics whose main parameter was Vs (stationary clot growth rate). The results of anticoagulant therapy were assessed by dynamics of clinical symptomatology, the findings of ultrasonographic angioscanning, and by the dynamics of laboratory parameters of plasma haemostasis.

The obtained findings demonstrated that anticoagulant therapy with nonfractionated heparin followed by switching to warfarin is an effective method of conservative treatment of patients with idiopathic thromboses, making it possible to attain laboratory confirmed hypocoagulation accompanied by both clinical and US-controlled improvements. The results of the thrombodynamics assay by the dynamics of a decrease in the D-dimer level made it possible to statistically significantly single out a group with no effect of heparin (no effect of hypocoagulation) and high sensitivity in singling out groups of ineffective therapy with warfarin, which on the background of normo- or hypercoagulation is a marker of increased fibrinogenesis and, consequently, of high risk for the development of recurrent thrombosis in such patients.

KEY WORDS: deep vein thrombosis, anticoagulant therapy, thrombodynamics assay.

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