Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients
Objective: to reveal early changes in the hemostatic system during warfarin therapy in cardiac surgical patients, by comprehensively evaluating their hemostatic status.Subjects and methods. Seventyfive patients receiving cardiac surgical treatment were examined. All the patients took warfarin for 5±...
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Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2015-09-01
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| Series: | Общая реаниматология |
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| Online Access: | https://www.reanimatology.com/rmt/article/view/1477 |
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| author | E. I. Goncharova E. A. Spiridonova A. N. Balandina A. V. Poletaev A. M. Sepoyan F. I. Ataullakhanov S. A. Rumyantsev N. N. Samsonova L. G. Klimovich E. A. Kornienko |
| author_facet | E. I. Goncharova E. A. Spiridonova A. N. Balandina A. V. Poletaev A. M. Sepoyan F. I. Ataullakhanov S. A. Rumyantsev N. N. Samsonova L. G. Klimovich E. A. Kornienko |
| author_sort | E. I. Goncharova |
| collection | DOAJ |
| description | Objective: to reveal early changes in the hemostatic system during warfarin therapy in cardiac surgical patients, by comprehensively evaluating their hemostatic status.Subjects and methods. Seventyfive patients receiving cardiac surgical treatment were examined. All the patients took warfarin for 5±1.5 days. Laboratory studies involving the determination of routine coagulogram readings and thrombodynamic indicators (lag time (Tlag) and rate (Vs) of clot growth, and concentrations of individual Factors II, VI, IX, and X) were used to evaluate the patients' hemostatic status.Results. 28% of the patients were found to have an international normalized ratio (INR) of above 3.0. There was a correlation of Tlag with INR (R2=0.66). Both indicators were comparatively highly correlated with Factor II and Factor X concentrations (R2=0.50 and 0.40 for Tlag; R2=0.53 and 0.48 for INR) and were uncorrelated with Factor IX levels (R2=0.20 for Tlag and 0.34 for INR). However, there was a difference in Factor VII concentrations: no correlation for Tlag (R2=0.20) whereas it for INR was rather high (R2=0.42). The index Vs was uncorrelated with INR (R2=0.24) and the concentration of blood coagulation factors (R2<0.1). There was a high correlation between Factor II and Factor X concentrations (R2=0.87); the correlation between the concentrations of all other pairs of coagulation factors was substantially lower (R20.45). The lack of correlation of a thrombodynamic indicator, such as clot growth rate, with the concentration of coagulation factors points to the fact that warfarin acts mainly on the phase of coagulation activation rather than that of clot propagation.Conclusion. The weak correlation between coagulation factors (except that of a pair of Factor II and Factor X) is indicative of the individual response of the patients to warfarin treatment and the need to monitor the hemostatic status by global hemostatic tests rather than by individual proteins. The thrombodynamic indicator Tlag reflects the effect of warfarin in proportion to INR. Warfarin virtually fails to affect the rate of clot growth so this indicator may be used to evaluate the patient's procoagulant status uncompensated for with warfarin intake. |
| format | Article |
| id | doaj-art-d892c6f76cc14deb8eb21ea739d616ca |
| institution | Kabale University |
| issn | 1813-9779 2411-7110 |
| language | English |
| publishDate | 2015-09-01 |
| publisher | Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia |
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| series | Общая реаниматология |
| spelling | doaj-art-d892c6f76cc14deb8eb21ea739d616ca2025-08-20T03:59:40ZengFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, RussiaОбщая реаниматология1813-97792411-71102015-09-01114515910.15360/1813-9779-2015-4-51-591463Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical PatientsE. I. Goncharova0E. A. Spiridonova1A. N. Balandina2A. V. Poletaev3A. M. Sepoyan4F. I. Ataullakhanov5S. A. Rumyantsev6N. N. Samsonova7L. G. Klimovich8E. A. Kornienko9A. A. Vishnevsky Central Military Clinical Hospital Three, Ministry of Defense of the Russian FederationDmitry Rogachev Federal ResearchandClinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of the Russian Federation; A. I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian FederationDmitry Rogachev Federal ResearchandClinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of the Russian FederationDmitry Rogachev Federal ResearchandClinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of the Russian FederationDmitry Rogachev Federal ResearchandClinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of the Russian FederationDmitry Rogachev Federal ResearchandClinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of the Russian Federation; Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of SciencesDmitry Rogachev Federal ResearchandClinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of the Russian Federation; N. I. Pirogov National Research Medical University, Ministry of Health of the Russian FederationA. N. Bakulev Research Center of Cardiovascular SurgeryA. N. Bakulev Research Center of Cardiovascular SurgeryA. A. Vishnevsky Central Military Clinical Hospital Three, Ministry of Defense of the Russian FederationObjective: to reveal early changes in the hemostatic system during warfarin therapy in cardiac surgical patients, by comprehensively evaluating their hemostatic status.Subjects and methods. Seventyfive patients receiving cardiac surgical treatment were examined. All the patients took warfarin for 5±1.5 days. Laboratory studies involving the determination of routine coagulogram readings and thrombodynamic indicators (lag time (Tlag) and rate (Vs) of clot growth, and concentrations of individual Factors II, VI, IX, and X) were used to evaluate the patients' hemostatic status.Results. 28% of the patients were found to have an international normalized ratio (INR) of above 3.0. There was a correlation of Tlag with INR (R2=0.66). Both indicators were comparatively highly correlated with Factor II and Factor X concentrations (R2=0.50 and 0.40 for Tlag; R2=0.53 and 0.48 for INR) and were uncorrelated with Factor IX levels (R2=0.20 for Tlag and 0.34 for INR). However, there was a difference in Factor VII concentrations: no correlation for Tlag (R2=0.20) whereas it for INR was rather high (R2=0.42). The index Vs was uncorrelated with INR (R2=0.24) and the concentration of blood coagulation factors (R2<0.1). There was a high correlation between Factor II and Factor X concentrations (R2=0.87); the correlation between the concentrations of all other pairs of coagulation factors was substantially lower (R20.45). The lack of correlation of a thrombodynamic indicator, such as clot growth rate, with the concentration of coagulation factors points to the fact that warfarin acts mainly on the phase of coagulation activation rather than that of clot propagation.Conclusion. The weak correlation between coagulation factors (except that of a pair of Factor II and Factor X) is indicative of the individual response of the patients to warfarin treatment and the need to monitor the hemostatic status by global hemostatic tests rather than by individual proteins. The thrombodynamic indicator Tlag reflects the effect of warfarin in proportion to INR. Warfarin virtually fails to affect the rate of clot growth so this indicator may be used to evaluate the patient's procoagulant status uncompensated for with warfarin intake.https://www.reanimatology.com/rmt/article/view/1477warfarinhemostasiscoagulation factorsthrombodynamics |
| spellingShingle | E. I. Goncharova E. A. Spiridonova A. N. Balandina A. V. Poletaev A. M. Sepoyan F. I. Ataullakhanov S. A. Rumyantsev N. N. Samsonova L. G. Klimovich E. A. Kornienko Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients Общая реаниматология warfarin hemostasis coagulation factors thrombodynamics |
| title | Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients |
| title_full | Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients |
| title_fullStr | Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients |
| title_full_unstemmed | Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients |
| title_short | Diagnosis of Impairments in the Hemostatic System in the Use of Warfarin in Cardiac Surgical Patients |
| title_sort | diagnosis of impairments in the hemostatic system in the use of warfarin in cardiac surgical patients |
| topic | warfarin hemostasis coagulation factors thrombodynamics |
| url | https://www.reanimatology.com/rmt/article/view/1477 |
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