LOW LEVEL OF ANTITHROMBIN III AS A WARNING SIGN FOR DEVELOPING THROMBOTIC COMPLICATIONS IN SURGICAL PATIENTS

Introduction. Pulmonary embolism (PE), being the most severe embolic complication, is characterised by low predictability, high mortality and incapacitation rates as well as a correspondingly high economic cost of therapy and aftercare. In this connection, the main purpose of our work is to find a warning for PE development in non-cardiosurgical patients that have undergone intensive therapy under conditions of general surgical ICU, among the indicators of the haemostasis system.

Materials and methods. Based at the anaesthesiology and emergency surgical department № 1 of the Kuvatov Republic Clinical Hospital (Russia), the researchers carried out an analysis of the haemostasis system in 430 patients hospitalised between 2010 and 2014. The functional activity of platelets was studied using a Biola 230LA laser platelet aggregation analyser (Russia). The determination of circulating aggregates was conducted using the Wu — Hoak method. Thromboelastography was carried out using a TEG 5000 Thromboelastograph (USA). A Stago STA Compact automated selective haemostasis analyser (France) was used to register indicators that characterise the state of endothelium, the haemostatic coagulation element and thrombosis and fibrinolysis markers.

Results. Univariate analysis demonstrated a connection between nosocomial episodes of thrombosis and the following factors: emergency surgery (OR 9.1, p<0.01), peripheral vessel disease (OR 13.5, p=0.01), collapse development in pre-operation period (OR 30, p<0.01), high content of D-dimers (OR 30, p<0.01) and low content of AT III (OR 13.5, p=0.01). The results of multifactor analysis show that the significant diagnostic criteria are high D-dimer content and low AT III venous blood activity.

Conclusion. A determination of high risks will enable the incidence of pulmonary embolism to be to minimised as well as provide a timely assessment of the efficiency of preventive measures carried out. 

1. European Society of Cardiology. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35:3033–80. DOI: 10.1093/eurheartj/ehu283

2. Caprini J.A., Glase S.J., Anderson C.B., Hathaway K. Laboratory markers in the diagnosis of venous thromboembolism. Circulation. 2004;109:I-4–I-8. DOI: 10.1161/01.CIR.0000122869.59485.36

3. Kodiatte T.A., Manikyam U.K., Rao S.B., Jagadish T.M., Reddy M., Lingaiah H.K.M., et al. Mean platelet volume in type 2 diabetes mellitus. J Lab Physicians. 2012;4(1):5–9. DOI: 10.4103/0974-2727.98662

4. Kuderer N.M., Poniewierski M.S., Culakova E., Lyman G.H., Khorana A.A., Pabinger I., et al. Predictors of venous thromboembolism and early mortality in lung cancer: results from a Global Prospective Study (CANTARISK). Oncologist. 2018;23(2):247–55. DOI: 10.1634/theoncologist.2017-0205

5. Etzioni D.A., Lessow C., Bordeianou L.G., Kunitake H., Deery S.E., Carchman E., et al. Venous thromboembolism after inpatient surgery in administrative data vs NSQIP: a multi-institutional study. J Am Coll Surg. 2018;S1072–7515(18)30123-6. DOI: 10.1016/j.jamcollsurg.2018.01.053

6. Freund Y., Cachanado M., Aubry A., Orsini C., Raynal P.A., FéralPierssens A.L., et al. Effect of the pulmonary embolism rule-out criteria on subsequent thromboembolic events among low-risk emergency department patients: The PROPER randomized clinical trial. JAMA. 2018;13;319(6):559–66. DOI: 10.1001/jama.2017.21904

7. Pasrija C., Kronfli A., Rouse M., Raithel M., Bittle G.J., Pousatis S., et al. Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: a single-center experience. J Thorac Cardiovasc Surg. 2018;155(3):1095–1106.e2. DOI: 10.1016/j.jtcvs.2017.10.139

8. Kohanna F.H., Smith M.H., Salzman E.W. Do patients with thromboembolic disease have circulating platelet aggregates? Blood. 1984;64(1):205–09. PMID: 6733272

9. Ozdemir B.A., Sinha S., Karthikesalingam A., Poloniecki J.D., Pearse R.M., Grocott M.P., Thompson M.M., Holt P.J. Mortality of emergency general surgical patients and associations with hospital structures and processes. Br J Anaesth. 2016;116(1):54–62. DOI: 10.1093/bja/aev372. PMID: 26675949

10. McCallum I.J., McLean R.C., Dixon S., O’Loughlin P. Retrospective analysis of 30-day mortality for emergency general surgery admissions evaluating the weekend effect. Br J Surg. 2016;103(11):1557–65. DOI: 10.1002/bjs.10261

11. Fitzgerald J.E.F., Khatri C., Glasbey J.C., Mohan M., Lilford R., Harrison E.M., et al. Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg. 2016;103(8):971–88. DOI: 10.1002/bjs.10151

12. Symons N.R.A., Moorthy K., Almoudaris A.M., Bottle A., Aylin P., Vincent C.A., et al. Mortality in high-risk emergency general surgical admissions. Br J Surg. 2013;100(10):1318–25. DOI: 10.1002/bjs.9208

13. Sinha S., Karthikesalingam A., Poloniecki J.D., Thompson M.M., Holt P.J. Inter-relationship of procedural mortality rates in vascular surgery in England retrospective analysis of hospital episode statistics from 2005 to 2010. Circ Cardiovasc Qual Outcomes. 2014;7:131–41. DOI: 10.1161/CIRCOUTCOMES.113.000579

14. Ozdemir B.A., Karthikesalingam A., Sinha S., Poloniecki J.D., VidalDiez A., Hinchliffe R.J., et al. Association of hospital structures with mortality from ruptured abdominal aortic aneurysm. Br J Surg. 2015;102(5): 516–24. DOI: 10.1002/bjs.9759

15. Qiu C., Chan P.H., Zohman G.L., Prentice H.A., Hunt J.J., LaPlace D.C., et al. Impact of anesthesia on hospital mortality and morbidities in geriatric patients following emergency hip fracture surgery. J Orthop Trauma. 2018;32(3):116–23. DOI: 10.1097/BOT.0000000000001035