Abstract:
About 2–3 % of the population and about 35–50 % of people over 65 years suffer from obliterating atherosclerosis of the main
arteries of the lower extremities. There are many known factors that potentiate atherosclerosis. Some of them are referred to as leading,
such as hyperlipoproteinemia or hypertension, others to concomitant contributing to the defeat of the arteries. According to J.S.A. Fuchs
include hypertension, hypercholesterolemia and smoking as major risk factors for atherosclerosis. They are less affected by obesity,
diabetes, hypertriglyceridemia, sedentary lifestyle, stress
Objective of the study. The purpose of this study is to evaluate the functional status of the vascular – platelet, coagulation and
fibrinolysis of the hemostasis system and their disorders using low – frequency piezoelectric thromboelastography (LPTEG) in patients
with obliterating atherosclerosis of the lower extremities on the background of treatment.
Materials and methods. The initial state of the hemostasis system was evaluated in 90 patients undergoing treatment for
obliterating atherosclerosis of the lower extremities in the Odessa Regional Clinical Hospital and MD Odreks. All patients underwent
surgery in the amount of femoral-popliteal autologous bypass grafting. Patients in the control (1st) group (45 patients) received analgesia
during surgery and in the postoperative period based on epidural administration of bupivacaine, and their treatment regimen included
enoxaparin 0.4 ml (40,000 anti-XA ME) 2 times a day subcutaneously into the anterolateral surface of the abdominal wall from the
first postoperative day and pentoxifylline IV 200 mg twice a day for 7 days. Patients of the studied (2nd) group (45 patients) received
analgesia during surgery and in the postoperative period on the basis of epidural administration of bupivacaine, also rivaroxaban 15 mg
2 times a day oraly on the first postoperative day was included in their treatment regimen.
The dynamics of the state of the hemostatic system in both groups of patients with OA was evaluated using LPTEG in the first
day before surgery and on the 3rd, 5th and 7th postoperative days.
Results and conclusions. Before surgery and the start of treatment in patients with OA, against the background of activation of
the vascular - platelet link of hemostasis, significant structural and chronometric hypercoagulation with increased thrombin generation
and activation of blood fibrinolytic activity are noted. Against the background of treatment in the 1st group, platelet aggregation tends to
normalize and there are significant differences compared with the indicators before treatment in the 1st group, the vascular-platelet and
fibrinolytic systems did not reach normal values before 7 days, but showed a significant downward trend the degree of manifestation of
their violations. Against the background of treatment of the 2nd group, significant changes were observed towards normalization in all
components of the hemostatic system according to the LPTEG technique. The state of the coagulation unit of the hemostasis system in
patients with OA on the 7th day of therapy does not significantly differ from the norm, it is possible to note significant shifts towards
hypocoagulation within the normal range. The fibrinolytic system on the 7th day of treatment does not statistically differ from normal
indicators, it has significant positive dynamics compared to 1 day. The second group revealed a statistically significant normalization of
all indicators characterizing the blood coagulation potential of the blood and the aggregation ability of platelets, as well as the indicator
that is responsible for changes in the fibrinolytic blood system.
