THROMBODYNAMIC PROPERTIES OF FIBRIN CLOTS IN PATIENTS WITH IHD AFTER CORONARY BYPASS SURGERY

Aim. To study how the state of the hemostatic system changes in patients with coronary heart disease undergoing coronary artery bypass surgery.

Methods. Observations were performed on 58 patients with coronary artery disease (45 men and 13 women) aged 42 to 75 years. All patients underwent coronary artery bypass surgery. 48 operations were performed using cardiopulmonary bypass and 9 on a working heart using myocardial stabilizers. We studied platelet count, activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen level, and spatial growth of a fibrin clot.

Results. It was established that in patients with coronary heart disease in the early postoperative period, the dynamic properties of the fibrin clot decrease, which is mainly due to consumption coagulopathy. This, in particular, is evidenced by a decrease in the number of platelets, an elongation of activated partial thromboplastin time (APTT), an elongation of the international normalized ratio (INR), and a decrease in the level of fibrinogen. At the same time, the number of leukocytes sharply increases in patients and the number of red blood cells decreases. Before discharging patients from the hospital, the thrombodynamic properties of the clot sharply increase and in some parameters (size and density of the fibrin clot) exceed the indicators in the preoperative period. Negative correlations between the density of the clot and the total blood loss were found. It has been shown that, without exception, all formed blood elements affect the thrombodynamic properties of a clot, including its density and size.

Conclusion. The early postoperative period is favorable both for the occurrence of thromboembolic complications and bleeding, while before discharge of the patient from the hospital, there is a risk of thrombosis.

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